Dental appliances with repositioning jaw elements

ABSTRACT

The present disclosure provides method, computing device readable medium, and devices for dental appliances with repositioning jaw elements. An example of a removable dental appliance includes a shell having a number of tooth apertures configured to receive and reposition a number of teeth of a patient along one jaw of a patient, a repositioning jaw element that extends from a buccal or lingual surface of the shell, the element having a first outer surface oriented to face the tongue of the patient surface and a second outer surface oriented to face the cheek of the patient, and a reinforcement member formed along at least one of the first and second outer surfaces to provide reinforcement of the repositioning jaw element.

PRIORITY

The present application is a Continuation-in-Part of U.S. patentapplication Ser. No. 14/491,765 filed Sep. 19, 2014, now U.S. Pat. No.10,537,406, issued on Jan. 21, 2020, which is a Continuation-in-Part ofU.S. patent application Ser. No. 14/186,856 filed Feb. 21, 2014, nowU.S. Pat. No. 9,844,424, issued on Dec. 19, 2017, which are incorporatedherein by reference in their entirety.

BACKGROUND

The present disclosure is related generally to the field of dentaltreatment. More particularly, the present disclosure is related tomethods, instructions on a computing device readable medium, and deviceswith repositioning jaw elements.

Dental treatments may involve, for instance, restorative and/ororthodontic procedures. Restorative procedures may be designed toimplant a dental prosthesis (e.g., a crown, bridge, inlay, onlay,veneer, etc.) intraorally in a patient. Orthodontic procedures mayinclude repositioning misaligned teeth and changing bite configurationsfor improved cosmetic appearance and/or dental function. Orthodonticrepositioning can be accomplished, for example, by applying controlledforces to one or more teeth over a period of time.

As an example, orthodontic repositioning may be provided through adental process that uses positioning appliances for realigning teeth.Such appliances may utilize a thin shell of material having resilientproperties, referred to as an “aligner,” that generally conforms to apatient's teeth but is slightly out of alignment with a current toothconfiguration.

Placement of such an appliance over the teeth may provide controlledforces in specific locations to gradually move the teeth into a newconfiguration. Repetition of this process with successive appliances inprogressive configurations can move the teeth through a series ofintermediate arrangements to a final desired arrangement (e.g., acorrected jaw position).

Such systems typically utilize materials that are light weight and/ortransparent to provide as a set of appliances that can be used seriallysuch that as the teeth move, a new appliance can be implemented tofurther move the teeth without having to take a new impression of thepatient's teeth at every increment of tooth movement in order to makethe successive appliance.

In various instances, teeth of a patient's upper jaw and teeth of thepatient's lower jaw may contact in an incorrect or suboptimal manner(e.g., crowding, crossbite, deep bite). A proper fit of the occlusalsurfaces of the teeth is necessary for proper biting and chewing, aswell as desirable for aesthetic appearance. Otherwise, premature wear ofthe teeth, undesirable flexion of the teeth, and/or undesirable forceson dental restorations may be experienced by the patient. For instance,a proper fit can be a function of the relative positions of teeth andthe mandible and maxilla, either of which may be retruded or protrudedrelative to the ideal position. The maxilla (e.g., the upper jaw) is abone that is fixed to the skull. The mandible (e.g., lower jaw) is abone that is attached to the skull by numerous muscles which guide itsmovement. The mandible articulates at its posterior upward extremitieswith the temporal bone to form the jaw joint. The jaw joint is a looselyconnected joint that accommodates the variety of movements of themandible relative to the maxilla during biting and chewing motions. Thenumerous muscles attaching the mandible to the skull control and powerthe complex movements involved in biting and chewing.

The position of the lower jaw is governed by at least two factors. Thefirst factor is the best fit or seating of the condyles of the mandiblewithin the joint housing of the temporal bone. The posterior superiormost position of the condyle in the joint is usually an ideal positionrepresenting full seating. The second factor is the best fit of theteeth between the maxilla and the mandible. Ideally, the teeth fittogether best in occlusion with the left and right jaw joint fullyseated at the same time, but this is not a requirement. Sometimes, theteeth fit together best with the condyles slightly displaced from thejoint. As a result, when the condyles are fully seated, the teeth maynot be in their best fitting position. This condition is known as ashift between the centric relationship (condyles fully seated) and thecentric occlusion (teeth best fitting).

Because the condylar relationship affords some flexibility in thepositioning of the jaw, the lower jaw can be intentionally repositionedin accordance with the best fit of the teeth, for instance, by using anorthodontic appliance. The orthodontic appliance used may or may not bedispleasing, both physically and aesthetically, to a patient undergoingtreatment which intentionally repositions the lower jaw.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A illustrates a side view of an upper jaw with a firstrepositioning jaw element and a lower jaw with a repositioning jawelement according to a number of embodiments of the present disclosure.

FIG. 1B illustrates a front view of an upper jaw with a firstrepositioning jaw element and a third repositioning jaw element and alower jaw with a second repositioning jaw element and a fourthrepositioning jaw element according to a number of embodiments of thepresent disclosure.

FIG. 1C illustrates a side view of a first shell with a firstrepositioning jaw element and a second shell with a second repositioningjaw element according to a number of embodiments of the presentdisclosure.

FIG. 2A illustrates a side view of an upper jaw with a firstrepositioning jaw element and a lower jaw with a second repositioningjaw element according to a number of embodiments of the presentdisclosure.

FIG. 2B illustrates a front view of an upper jaw with a firstrepositioning jaw element and a third repositioning jaw element and alower jaw with a second repositioning jaw element and a fourthrepositioning jaw element according to a number of embodiments of thepresent disclosure.

FIG. 3 illustrates an example of a method for separating an upperdentition from a lower dentition according to a number of embodiments ofthe present disclosure.

FIGS. 4A-4C illustrate examples of repositioning jaw elements accordingto a number of embodiments of the present disclosure.

FIGS. 5A-5C illustrate examples of repositioning jaw elements accordingto a number of embodiments of the present disclosure.

FIG. 6 illustrates an example computing device readable medium havingexecutable instructions that can be executed by a processor to perform amethod according to one or more embodiments of the present disclosure.

FIGS. 7A-7D illustrate examples of a plurality of devices forrepositioning jaws according to a number of embodiments of the presentdisclosure.

FIGS. 8A-8D illustrate examples of repositioning jaw elements accordingto a number of embodiments of the present disclosure.

FIGS. 9A-9B illustrate examples of features of devices for repositioningjaws according to a number of embodiments of the present disclosure.

FIGS. 10A-10C illustrate examples of occlusal features of devices forrepositioning jaws according to a number of embodiments of the presentdisclosure.

FIGS. 11A-11B illustrate examples of devices for repositioning jawsaccording to a number of embodiments of the present disclosure.

FIGS. 12A-12B illustrate examples of devices according to a number ofembodiments of the present disclosure.

FIGS. 12C-12D illustrate examples of repositioning jaw elementsaccording to a number of embodiments of the present disclosure.

FIGS. 13A-13B illustrate examples of side surface features according toa number of embodiments of the present disclosure.

FIGS. 13C-D illustrate a side view of a first shell with a first sidesurface feature and a second shell with a second side surface accordingto a number of embodiments of the present disclosure.

FIGS. 14A-14B illustrate examples of repositioning jaw elements foradjusting a midline of a patient according to a number of embodiments ofthe present disclosure.

FIGS. 15A-15B illustrates a side view of a first shell with a firstrepositioning jaw element and a second shell with a second repositioningjaw element according to a number of embodiments of the presentdisclosure.

FIG. 16A illustrates a side view of a first shell with a firstrepositioning jaw element and a second shell with a second repositioningjaw element according to a number of embodiments of the presentdisclosure.

FIG. 16B illustrates a cross-sectional view of the second repositioningjaw element according to a number of embodiments of the presentdisclosure.

FIG. 17 illustrates a side close-up view of a repositioning jaw elementreinforcement structure according to a number of embodiments of thepresent disclosure.

FIGS. 18A and 18B illustrate perspective views of a repositioning jawelement reinforcement structure according to a number of embodiments ofthe present disclosure.

FIG. 19 illustrates an elevated perspective view of a virtual model foruse in creating repositioning jaw elements having buccal and lingualreinforcement structures according to a number of embodiments of thepresent disclosure.

FIG. 20 illustrates a side perspective view of a virtual model for usein creating repositioning jaw elements having buccal reinforcementstructures according to a number of embodiments of the presentdisclosure.

FIG. 21 illustrates an elevated perspective view of a virtual model foruse in creating repositioning jaw elements having buccal reinforcementstructures according to a number of embodiments of the presentdisclosure.

DETAILED DESCRIPTION

As discussed above, the present disclosure provides methods,instructions on computing device readable medium, and devices forrepositioning jaw elements. Generally, the repositioning occurs duringan orthodontic treatment which is a process of moving and reorientingteeth for functional and/or aesthetic purposes, although repositioningmay be made for other purposes.

Simultaneous contacting of the upper and lower teeth on the right andleft sides, and in the anterior and posterior occlusal areas withmaximum interdigitation is desired for proper positioning of the lowerjaw to the upper jaw in the mouth of a patient. An unbalanced occlusion,such as a malocclusion, is disruptive to the proper biting and chewingfunctions because excessive forces may be placed in a particular areathat can lead to premature wear and/or restoration failure, or becauseundesirable forces such as flexion may lead to stresses which causeabfraction lesions and/or crowding/spacing of the teeth. The position ofa patient's jaw can be changed, for instance, using an orthodonticappliance (e.g., a dental appliance).

Current approaches for jaw repositioning, such as those performed priorto fixed orthodontic treatment (i.e., “braces”) include having atreatment professional place an orthodontic appliance which may includeblock elements, wires, tensioning springs, horizontal stops, etc., whichis firmly fixed to the teeth and which applies repositioning forces tomove the jaw of the patient, thereby causing the relative positioning ofthe patient's upper and lower jaws to adjust. Some believe that thisrepositioning stimulates jaw growth in patients with growth potentialremaining, while others believe that the muscles can re-learn a newposition so long as the teeth are made to fit together well in the newjaw position. In some instances, prior approaches include a removableappliance with block elements.

Current appliances for jaw repositioning are not designed to repositionthe teeth during the process of jaw repositioning. After adjustment ofthe position of the patient's jaw, further orthodontic treatment isperformed to move and re-orientate the teeth of the patient for improveddental interdigitation, if necessary. Many of the current jawrepositioning devices can be displeasing to patients, both physicallyand aesthetically, because the patient does not have the option toremove the appliance even for a short period of time. Such appliances(e.g., Herbst appliance) are typically cemented into place on thepatient's teeth. Depending on whether the jaw change is due to growth ormuscular repositioning, realigning the teeth of a patient afterrepositioning the jaw can result in reversion of the position of the jawif the teeth are not positioned and/or repositioned in a manner thatbest supports the new jaw position. This would occur, for example, ifthe teeth fit better in a jaw position different from the one which isaccomplished through the jaw repositioning phase of the treatment. Inthis situation, the jaw would revert toward its original position orwhatever position is most comfortable for the patient when biting sincethe jaw repositioning appliance has been removed. Therefore, the desireis to reposition the jaw to an optimal relation while at the same timearrange the teeth such that they fit together the best both in archcoordination between the upper and lower arches and in interdigitationbetween the arches. The interdigitation makes the patient more likely tokeep the lower jaw in the new position since the teeth fit together thebest in the interdigitated position.

Repositioning a jaw (e.g., separation of occlusal surfaces and/or movingforward or backward the position of a lower jaw) according toembodiments of the present disclosure can include utilizing a set of oneor more appliances, such as positioners, retainers, and/or otherremovable appliances (e.g., clear shells and/or aligners) having a shellto be worn over the teeth of a patient and having a first repositioningjaw element thereon that is positioned to interface, interact, and/orengage a second repositioning jaw element on an appliance on an opposingjaw for separating occlusal surfaces of the patient's upper dentitionand lower dentition and/or to reposition the patient's jaw. Therepositioning jaw elements can place a force on the lower jaw of thepatient to sagittally move the lower jaw. Sagittal movement of a jaw, asused herein, can include revising a position of a lower jaw relative tothe upper jaw (e.g., in a forward or backward direction). For instance,the position of the patient's lower jaw can shift sagittally tostimulate jaw growth in patients with growth potential remaining and/orto allow muscles to re-learn a new position.

In various embodiments, the movement can be controlled to reposition thepatient's jaw in an anterior-posterior plane with respect to the jaws ofthe patient. For example, the first repositioning jaw element and thesecond repositioning jaw element can be positioned to interface as thepatient moves to a fully engaged sagittal jaw position of the patient'supper dentition and the patient's lower dentition and wherein thismovement is designed to reposition the patient's jaw in ananterior-posterior plane with respect to the jaws of the patient.

For example, one or more embodiments can include providing a virtualmodel of a dental appliance having a shell configured to reposition anumber of teeth of a patient. The virtual model of the dental appliancecan, for instance, be created from a virtual model of the jaw of thepatient and/or from a physical mold of the jaw of the patient. A virtualrepositioning jaw element can, for example, be positioned on the shellof the virtual model of the dental appliance parallel to a bite plane ofthe patient and/or can extend from a surface of the shell of the virtualmodel of the dental appliance. The positioning of the virtualrepositioning jaw element and/or the design of the virtual repositioningjaw element can be based on and/or included in a treatment plan. Forinstance, the treatment plan can include a desired, ideal, and/or finaljaw position. The virtual model of the dental appliance with the revisedposition of the repositioning jaw element can be used to create aphysical dental appliance, for instance, as discussed further herein.

A dental appliance, in accordance with some embodiments of the presentdisclosure, can include a first shell having a number of tooth aperturesconfigured to receive and reposition a number of teeth of a patient'supper dentition and a second shell having a number of tooth aperturesconfigured to receive and reposition a number of teeth of the patient'slower dentition. Each shell (e.g., the first shell and second shell) canhave a repositioning jaw element extending from a surface of the shells.The repositioning jaw elements can be positioned in each respectiveshell to interact and/or interface at surfaces in the presence of afully engaged sagittal jaw position of the patient's upper jaw and thepatient's lower jaw in order to reposition the patient's jaw and/orseparate occlusal surfaces of the patient's teeth for treatmentpurposes. A fully engaged sagittal jaw position, as used herein, caninclude a relationship of the mandible and the maxilla when the upperand lower jaw are closed as far as the dental appliance with therepositioning jaw elements will allow (e.g., a partial occlusal jawposition).

For example, the separation of occlusal surfaces of the patient's teethcan be used to treat sagittal malocclusions (including crossbites), deepbites, open bites, and/or other malocclusions, in various embodiments.The repositioning jaw elements can be positioned such that therepositioning jaw elements avoid interference with the shells of thedental appliance that are used to align the teeth. For instance, theseparation of occlusal surfaces can include the occlusal surfaces of atleast some of the teeth within and/or a portion of occlusal surfaces ofthe shells interacting with one or more surfaces of the repositioningjaw elements of a shell on an opposing jaw. In this manner, a dentalappliance in accordance with embodiments of the present disclosure canbe used to concurrently treat sagittal malocclusions, includingcrossbite and/or deep bite, while simultaneously repositioning a numberof teeth of the patient. Further, in some embodiments, all of this toothand jaw movement can be planned via computing device executableinstructions and therefore, excessive or redundant movements between thetwo typically separate processes can be avoided. Additionally, a virtualmodel can be created and tested so that the patient does not have to besubjected to trial and error to achieve proper jaw and teethpositioning. The ability to visualize the repositioned jaws andestablish the alignment in the repositioned configuration isadvantageous because the best alignment of the teeth when the jaw isrepositioned can be precisely established and can be different from thealignment when the jaws are not repositioned into an improved or optimalposition.

In some embodiments, a plurality of appliances can be worn by a patientsuccessively to achieve gradual simultaneous and/or sequentialrepositioning of the patient's jaw and/or gradual tooth movement. Forinstance, each of a plurality of dental appliance can reposition thepatient's jaw in incremental distances. In such embodiments, thepositions of the repositioning jaw elements can be adjusted to allow thetreatment professional to fine tune the movement of the jawsymmetrically or asymmetrically and/or to move the teeth incrementallywhich may be less painful than with fixed appliances which may impartmore sudden force in the initial period of the process than later in theprocess, among other benefits.

In the detailed description of the present disclosure, reference is madeto the accompanying drawings that form a part hereof, and in which isshown by way of illustration how one or more embodiments of thedisclosure may be practiced. These embodiments are described insufficient detail to enable those of ordinary skill in the art topractice the embodiments of this disclosure, and it is to be understoodthat other embodiments may be utilized and that process, electrical,and/or structural changes may be made without departing from the scopeof the present disclosure. As used herein, the designator “N” and “P”,particularly with respect to reference numerals in the drawings,indicates that a number of the particular feature so designated can beincluded. As used herein, “a number of” a particular thing can refer toone or more of such things (e.g., a number of teeth can refer to one ormore teeth).

The figures herein follow a numbering convention in which the firstdigit or digits correspond to the drawing figure number and theremaining digits identify an element or component in the drawing.Similar elements or components between different figures may beidentified by the use of similar digits. For example, 106 may referenceelement “06” in FIG. 1, and a similar element may be referenced as 206in FIG. 2. As will be appreciated, elements shown in the variousembodiments herein can be added, exchanged, and/or eliminated so as toprovide a number of additional embodiments of the present disclosure. Inaddition, as will be appreciated, the proportion and the relative scaleof the elements provided in the figures are intended to illustratecertain embodiments of the present disclosure, and should not be takenin a limiting sense.

FIG. 1A illustrates a side view of an upper jaw 102 with a firstrepositioning jaw element 106 and a lower jaw 104 with a secondrepositioning jaw element 108 according to a number of embodiments ofthe present disclosure. The upper jaw 102, the first repositioning jawelement 106, the lower jaw 104, and the second repositioning jaw element108 illustrated in FIG. 1A include virtual images of jaws andrepositioning jaw elements, respectively (e.g., virtual jaws and/orvirtual repositioning jaw elements), as discussed further herein. Theupper jaw 102 can include a maxilla, its related soft and hard tissues,and can include a number of teeth of a patient's upper dentition. Thelower jaw 104 can include a mandible, its related soft and hard tissues,and can include a number of teeth of the patient's lower dentition.

In some instances, the patient may exhibit abnormal occlusion ormalocclusion. For instance, this may include a jaw (or both) that isprotrusive, retrusive, or laterally displaced. As an example,positioning of the number of teeth of the patient's upper dentition andthe number of teeth of the patient's lower dentition can be such thatthe best fit of the upper dentition with the lower dentition results ina misalignment of the lower jaw 104 relative to the upper jaw 102 eitherin positional relations or at the level of the jaw joint which connectsthe lower jaw 104 to the upper jaw 102. The lower jaw 104 can be in aretruded position, for instance, resulting in a distance (e.g., space)between the front teeth of the upper dentition and the front teeth ofthe lower dentition (e.g., an increased overjet). Correction of themalocclusion can be beneficial to the patient in terms of improvedchewing ability, reduced premature wear of the teeth, and/or improvedfacial aesthetics.

In some embodiments, the upper jaw 102 and lower jaw 104 illustrated inFIG. 1A can include a virtual model of the patient's upper jaw and lowerjaw. A virtual model of one or more dental appliances (e.g., anappliance for the upper dentition and an appliance for the lowerdentition which may also be connected together) each having a shellconfigured to reposition a number of teeth of the patient can beprovided. The virtual model of the dental appliance can include avirtual model of a dental appliance configured to reposition the numberof teeth of the patient.

Repositioning jaw elements can be positioned on occlusal, buccal, and/orlingual surfaces of a dental appliance to be placed over the patient'steeth. A repositioning jaw element, as used herein, can include aportion of material (e.g., a geometric shaped element, such as a blockshape) extending from a surface of the shell of the appliance, asdiscussed further herein. For instance, a virtual repositioning jawelement can be positioned on the shell of the virtual model of thedental appliance parallel to an occlusal plane of the patient. Anocclusal plane, as used herein, can include a surface from the incisaledges of the incisors and the tips of the occluding surfaces of theposterior teeth that is a mean of the curvature of the surface.

In some embodiments, the position of the virtual repositioning jawelement can be revised to align with a midline (e.g., middle) of atleast one tooth of the number of teeth wherein the virtual repositioningjaw element extends from a surface of the shell of the virtual model ofthe dental appliance. However, embodiments in accordance with thepresent disclosure are not so limited and the virtual repositioning jawelements may not be aligned with a midline of the at least one tooth invarious embodiments. The virtual model of the dental appliance,including the virtual repositioning jaw element, can be used todetermine a treatment plan for the patient and/or to form a physicaldental appliance and/or physical repositioning jaw element (e.g., asdiscussed further herein).

The physical repositioning jaw element can be formed of a variety ofmaterial types. In some embodiments, the physical repositioning jawelement can be formed of the same material as the shell of the dentalappliance (e.g., a polymeric material). For instance, the physicalrepositioning jaw element can be formed integrally with the shell and/orformed of a same material as the shell.

The repositioning jaw elements can also be positioned in differentplaces, in some embodiments. For example, the first repositioning jawelement 106 and the second repositioning jaw element 108 can bepositioned near occlusal surfaces of the teeth of the patient to advancethe placement of the lower jaw 104 in a forward direction (e.g., in ananterior direction and/or toward a patient's lips) or in a backwarddirection (e.g., in an posterior direction and/or towards the back ofthe patient's head). For instance, occlusal surfaces of teeth of theupper jaw 102 and lower jaw 104 can be separated using the firstrepositioning jaw element 106 and the second repositioning jaw element108 to move (e.g., to move sagittally) the lower jaw 104 of the patientfrom an articulation path during opening (e.g., the path that the jawcurrently follows when opening) to a desired range of jaw openingextending from an advanced or forward position of occlusion, asdescribed further herein. As an example, the first repositioning jawelement 106 can include a first surface 128 and the second repositioningjaw element 108 can include a second surface 130 to interface, interact,and/or otherwise engage with the first surface 128 of the firstrepositioning jaw element 106, as discussed further herein. By movingthe lower jaw 104, muscles associated with movement of the lower jaw 104can be retrained to a new position (generally in a forward and/ordownward direction, or in a backward direction) or the lower jaw may bepermitted to grow more fully if the patient has not fully developedskeletally.

FIG. 1B illustrates a front view of an upper jaw 102 with a firstrepositioning jaw element 106 and a third repositioning jaw element 110and a lower jaw 104 with a second repositioning jaw element 108 and afourth repositioning jaw element 112 according to a number ofembodiments of the present disclosure. A front view, as used herein, caninclude an anterior view and/or a more anterior view of the jaws ascompared to a side view. The upper jaw 102, the first repositioning jawelement 106, the third repositioning jaw element 110, the lower jaw 104,the second repositioning jaw element 108, and the fourth repositioningjaw element 112 illustrated in FIG. 1B can include virtual images ofjaws and repositioning jaw elements, respectively (e.g., virtual jawsand/or virtual repositioning jaw elements), as discussed further herein.As illustrated by FIG. 1B, two repositioning jaw elements (e.g., thefirst repositioning jaw element 106 and the third repositioning jawelement 110) can be positioned near (e.g., adjacent to) occlusalsurfaces of the upper jaw 102 and two repositioning jaw elements (e.g.,the second repositioning jaw element 108 and the fourth repositioningjaw element 112) can be positioned near occlusal surfaces of the lowerjaw 104.

The first repositioning jaw element 106 can be positioned near theocclusal surfaces of the posterior teeth (in the embodiment illustratedby FIG. 1B, the molars and/or bicuspids) of the upper jaw 102 and thesecond repositioning element 108 can be positioned near the occlusalsurfaces of the posterior teeth (in the embodiment illustrated by FIG.1B, the bicuspids) of the lower jaw 104. The first repositioning jawelement 106 and second repositioning jaw element 108 can be located neara first posterior side of the patient's dentition.

The first repositioning jaw element 106 and the second repositioning jawelement 108 can include surfaces that can interface, interact, and/orengage with a surface of a repositioning jaw element on a shell of anopposing jaw. For instance, a first surface of the first repositioningjaw element 106 can interface, interact, and/or engage with a secondsurface of the second repositioning jaw element 108. A surface, as usedherein, can include a side and/or end surface of a repositioning jawelement. In some embodiments, the first surface can include a slantedsurface on a mesial-facing surface of the first repositioning jawelement 106 and/or the second surface can include a slanted surface on adistal-facing surface of the second repositioning jaw element 108, forinstance. For example, a mesial-facing surface can include a surface ofa repositioning jaw element that is in a direction toward the anteriormidline of the teeth. A distal-facing surface can include a surface of arepositioning jaw element that is in a direction toward the last toothin each quadrant of a dental arch. However, embodiments in accordancewith the present disclosure are not so limited. A mesial-facing surface,in some embodiments, can be facing toward the facial plane (e.g., normalto the facial plane), whereas a distal-facing surface can be facing awayfrom the facial plane (e.g., normal to the facial plane but in theopposite direction). The surfaces of the repositioning jaw elements, inaccordance with embodiments of the present disclosure, can be orientedin a variety of directions.

The third repositioning jaw element 110 can be positioned near theocclusal surfaces of the posterior teeth (in embodiment illustrated byFIG. 1B, molars and/or bicuspids) of the upper jaw 102 and the fourthrepositioning jaw element 112 can be positioned near the occlusalsurfaces of the posterior teeth (in the embodiment illustrated by FIG.1B, bicuspids) of the lower jaw 104. The third repositioning jaw element110 and the fourth repositioning jaw element 112 can be located near asecond posterior side of the patient's dentition. The thirdrepositioning jaw element 110 and the fourth repositioning jaw element112 can include surfaces that can interface, interact, and/or engagewith a surface of a repositioning jaw element on an opposite jaw. Forinstance, a third surface of the third repositioning jaw element 110 caninterface, interact, and/or engage with a fourth surface of the fourthrepositioning jaw element 112. The third surface can include a slantedsurface on a mesial-facing surface of the third repositioning jawelement 110 and the fourth surface can include a slanted surface on adistal-facing surface of the fourth repositioning jaw element 112, forinstance.

However, embodiments in accordance with the present disclosure are notso limited. For instance, the surfaces of the repositioning jaw elements106, 108, 110, 112 can be oriented in a variety of directions. Forinstance, the first surface of the first repositioning jaw element 106and the third surface of the third repositioning jaw element 110 caninclude distal-facing slanted surfaces and/or the second surface of thesecond repositioning jaw element 108 and the fourth surface of thefourth repositioning jaw element 112 can include mesial-facing slantedsurfaces, among other orientations.

The surfaces (e.g., that interact and/or interface) of the repositioningjaw elements 106, 108, 110, 112 can be angled, in various embodiments,to guide the lower jaw 104 into position and gain desired lateral orprevent unwanted lateral movement. The surfaces can be angled inbuccal-lingual and/or mesial-distal direction, for example. The angle ofinteracting and/or interfacing surfaces (e.g., two surfaces that aredesigned to interface, interact, and/or engage with each other eitheractively or passively) can have the same degree and/or slant or adifferent degree and/or slant (e.g., as illustrated by the embodiment ofFIGS. 14A-14B).

For example, the first surface of the first repositioning jaw element106 and the second surface of the second repositioning jaw element 108can interface at a first slant. The slant can include, for instance, adegree of angle of the repositioning jaw elements. The third surface ofthe third repositioning jaw element 110 and the fourth surface of thefourth repositioning jaw element 112 can interface at a second slant.

The first slant and the second slant, in accordance with a number ofembodiments, can include opposing angles. The opposing angles of slantson opposing posterior sides of the patient's dentition can facilitatedesired lateral movement or limit and/or prevent unwanted lateralmovement. In some embodiments, the sum of the opposing angles caninclude 180 degrees. As an example, if the first slant is 70 degreesthen the second slant can include 110 degrees.

In accordance with some embodiments, the repositioning jaw elements 106,108, 110, 112 extending from surfaces of a shell can be used to generatedistalizing force on at least some of the teeth that are located withinthe shell. For example, when the repositioning jaw elements 106, 108,110, 112 interface, the distalizing forces can be isolated to posteriorteeth of the upper jaw. The distalizing forces can, in some embodiments,cause tooth movement of the upper jaw posterior teeth in a distaldirection. As such, the repositioning jaw elements 106, 108, 110, 112 invarious embodiments can be a substitute for Class II elastics.

In some embodiments, the repositioning jaw elements 106, 108, 110, 112can include geometric features to engage with a repositioning jawelement on an opposing jaw. Geometric features, as used herein, caninclude a variety of protruding geometric shapes (e.g., cylinder,rectangular, etc.) and/or receding geometric shapes (e.g., negativespace that matches the protruding geometric shape on a repositioning jawelement on an opposing jaw, as illustrated in the embodiment of FIG.8A). For example, a geometric feature on the first surface of the firstrepositioning jaw element 106 can include a convex cylindrical shapedfeature and a geometric feature on the second surface of the secondrepositioning jaw element 108 can include a concave cylindrical shapedfeature shaped to mate with the geometric feature on the first surfaceof the first repositioning jaw element 106.

In some embodiments, the geometric features of a first repositioning jawelement and/or a second repositioning jaw element can include aprotrusion and a socket. A socket, in various embodiments, can include aconvex geometric shape that is shaped to mate with a geometric shape onan opposing jaw (e.g., as discussed further herein). For example, afirst repositioning jaw element can include a protrusion extending fromthe first repositioning jaw element in a direction toward occlusalsurfaces of the opposing jaw. The second repositioning jaw element caninclude a socket within the second repositioning jaw element. Theprotrusion of the first repositioning jaw element can fit into thesocket of the second repositioning jaw element to assist in guiding thelower jaw into a forward position or a backward position.

Alternatively, the protrusion and/or socket can be located within and/orextend from a surface of the shell. In some instances, one or moresockets can be located within and/or extend from a surface of the firstshell located behind anterior teeth of the upper jaw. In such anembodiment, the lower incisor teeth can fit into the one or more socketsto guide the lower jaw into a forward position or backward position.

Although the present embodiments discuss guiding a jaw into a forwardposition or backward position, embodiments in accordance with thepresent disclosure are not so limited. For example, embodiments inaccordance with the present disclosure can include guiding a jaw in avariety of directions, such as a mesial-distal direction, as discussedfurther herein with regards to the embodiment illustrated in FIGS.14A-14B.

FIG. 1C illustrates a side view of a first shell 114 with a firstrepositioning jaw element 106 and a second shell 116 with a secondrepositioning jaw element 108 according to a number of embodiments ofthe present disclosure. The side view can, for instance, include aprofile view of the first shell 114 and the second shell 116. The firstshell 114 and the second shell 116, in some embodiments, can include aremovable dental appliance.

Appliances can include any positioners, retainers, and/or otherremovable dental appliances for finishing, inducing (e.g., causing smallmovements in teeth), or maintaining teeth position in connection with adental treatment. These appliances may be utilized by the treatmentprofessional in completing a treatment plan. For example, a treatmentplan can include the use of a set of dental appliances, createdaccording to models described herein.

An appliance can, for example, be fabricated from a polymeric shell,and/or formed from other material, having a number of cavities shaped(e.g. tooth apertures) to receive and apply force to reposition one ormore teeth from one geometric tooth arrangement to one or moresuccessive tooth arrangements. There may be several appliances that maybe needed to move the teeth from the beginning of a dental treatmentplan to the end of the plan. The shell may be designed to fit over anumber of, or in many instances all, teeth present in the upper and/orlower jaw. For example, a shell can have a cavity that includes a numberof tooth apertures for placement of teeth therein. Each tooth aperturecan include an interior surface (e.g., directly adjacent to the surfacesof the teeth placed therein) and an exterior surface. The interiorsurface is configured to receive and reposition a number of teeth of thepatient, for example.

The first shell 114 can include a number of tooth apertures configuredto receive and reposition a number of teeth of a patient's upperdentition. As illustrated by FIG. 1C, a first repositioning jaw element106 can extend from a surface of the first shell 114. The firstrepositioning jaw element 106 can extend from an occlusal surface of thefirst shell 114. An occlusal surface of a shell, as used herein, caninclude an exterior surface of the shell adjacent to and/or extendingtoward the occlusal surfaces of the teeth on an opposing jaw of thepatient.

The second shell 116 can include a number of tooth apertures configuredto receive and reposition a number of teeth of the patient's lowerdentition. A second repositioning jaw element 108 can extend from asurface of the second shell 116. For instance, the second repositioningjaw element 108 can extend from an occlusal surface of the second shell116.

As illustrated by FIG. 1C, a shell with a repositioning jaw element,such as the first shell 114 with the first repositioning jaw element 106and the second shell 116 with the second repositioning jaw element 108,include continuous dental appliances that contain geometries (e.g., therepositioning jaw elements) that act as repositioning jaw elements. Thatis, the repositioning jaw elements 106, 108 are geometries of the shells114, 116, and not separate elements attached thereto.

The first repositioning jaw element 106 can include a first surface 128and the second repositioning jaw element 108 can include a secondsurface 130 to interface with the first surface 128 of the firstrepositioning jaw element 106. For example, as illustrated by theembodiment of FIG. 10, the first repositioning jaw element 106 and thesecond repositioning jaw element 108 can be positioned to interface,interact, and/or otherwise engage in the presence of a fully engagedsagittal jaw position of the patient's upper dentition (e.g., the upperjaw 102 illustrated in FIGS. 1A-1B) and the patient's lower dentition(e.g., the lower jaw 104 illustrated in FIGS. 1A-1B) in a manner toreposition the patient's lower jaw. The reposition of the patient'slower jaw can, for instance, include moving (e.g., moving sagittally) alower jaw of the patient from an existing articulation reflex path ofopening to a desired more extended range of jaw opening whereby thelower jaw is moved forward or backward into a new sagittal jaw position.

Alternatively and/or in addition, the repositioning of the patient's jawcan include a separation of occlusal surfaces of the number of teeth ofthe patient's upper dentition from occlusal surfaces of the number ofteeth of the patient's lower dentition as the patient moves to a fullyengaged sagittal jaw position. For instance, separating occlusalsurfaces can include separating occlusal surfaces to a thresholddistance to prevent an occlusal surface of the first shell 114 fromcontacting or engaging an occlusal surface of the second shell 116. Thethreshold distance can include a particular value. For example, thethreshold distance can include one millimeter or less, among othervalues. As discussed above, the separation of occlusal surfaces caninclude the occlusal surfaces of at least some of the teeth within ashell and/or at least some of an occlusal surface of the shellcontacting or engaging with one or more surfaces of the repositioningjaw element of a shell on an opposing jaw.

As illustrated by FIG. 1C, the first repositioning jaw element 106 caninclude a slanted top surface. For example, a slanted top surface caninclude a slant in height from the first surface 128 to the back surfaceof the first repositioning jaw element 106 (e.g., back surface 538 asillustrated by FIG. 5C).

Further, the first surface 128 of the first repositioning jaw element106 and the second surface 130 of the second repositioning jaw element108 can include a slant, as further described herein. For example, asillustrated by FIG. 1C and further illustrated by FIG. 4A, the firstsurface 128 can be a slanted mesial-facing surface of the firstrepositioning jaw element 106 and the second surface 130 can be aslanted distal-facing surface of the second repositioning jaw element108. The surfaces 128, 130 can interface at the slant (e.g., the angledsurfaces), for instance.

The combination of the slanted top surface of the first repositioningjaw element 106, the slant of the first surface 128, and/or the secondsurface 130 can, for instance, allow for error in predicting thecorrected jaw position of the patient when designing the first shell 114and the second shell 116. For example, the first shell 114 and thesecond shell 116 can be designed for a predicted corrected jaw positionthat is different from an actual corrected jaw position of the patient(e.g., the predicted corrected jaw position may be inaccurate ascompared to the actual corrected jaw position of the patient).

A corrected jaw position can, for example, be a relation of the upperjaw and the lower jaw that is a corrected (e.g., changed) as compared toa current jaw position of the patient. For example, a corrected jawposition can include an optimal relation of the upper jaw and the lowerjaw (e.g., an ideal jaw position), a more optimal relation of the upperand lower jaw than the current jaw position, and/or an overcorrectedposition (e.g., lower jaw can protrude forward more than an optimalrelation/an advanced jaw position). For example, in some embodiments,the corrected jaw position can be an incremental movement toward theoptimal relation of the upper jaw and the lower jaw.

The first shell 114 and second shell 116 may be designed for aninaccurate predicted corrected jaw position. However, due to the slantedtop surface of the first repositioning jaw element 106 and the slant ofthe first and second surfaces 128, 130, the first and secondrepositioning jaw elements 106, 108 can have an ideal fit when worn bythe patient.

An ideal fit, as used herein, is a fit of the repositioning jaw elementswhen the patient's jaw is closed. For example, an ideal fit can be aposition and fit of the repositioning jaw elements that can repositionthe patient's jaw toward a corrected jaw position. A corrected jawposition can be predicted using patient data. However, the predictedcorrected jaw position may not always be accurate due to limited patientdata available.

In a number of embodiments, the patient data can include articulationinformation. For example, articulation information of a patient can beinput using a scanned bite registration with the patient biting into asoft wax in an advanced position and matching the scan to fit thescanned bite registration. An advanced position, as used here, caninclude a forward position of the lower jaw relative to the upper jaw.Alternatively, an articulator and a facebow transfer can be used tocreate articulated models and the articulated position can be input to acomputing device. That is, a scan of the actual bite or of a mountedarticulation of the bite can be input and used to design (e.g.,position) the repositioning jaw elements.

The ideal fit of the repositioning jaw elements can take into accountpotential errors in predicting the corrected jaw position and/orvariations in jaw relation of the patient due to movement of the jawfrom a fully closed position. For example, a patient's jaw may notalways be positioned in a fully closed position. Design of therepositioning jaw elements, in accordance with the present disclosure,can allow for a corrected jaw position to be incorrectly predictedand/or for the relation of the patient's jaw to move and still separatethe jaw an intended height and/or toward an intended position.

That is, the repositioning jaw elements 106, 108 can separate the jawsan intended height and/or move the jaw toward an intended position evenwith an inaccurate predicted corrected jaw position. A dental appliancewithout the slanted top surface and/or slant of the first and secondsurfaces that is designed for an inaccurate predicted corrected jawposition can separate the jaws a greater (or lesser) height than theintended height and/or move the jaw past (or less than) the intendedposition.

In some embodiments, the separation of occlusal surfaces can be used fortreatment of sagittal malocclusion, including excess overjets andanterior crossbite, the correction of transverse malocclusions includinglateral crossbites, and/or vertical problems such as deep bite.Malocclusions can be treated using the repositioning jaw elements 106,108 (in addition to a third repositioning jaw element 110 and fourthrepositioning jaw element 112 on the opposing posterior side of the jaw,in some embodiments, as illustrated by the embodiment of FIG. 1B) toreposition the jaw of the patient. In some situations, such as anteriorcrossbite and deep bite can be treated using the repositioning jawelements 106, 108 to allow for individual movement of teeth while thejaws are repositioned into a new relative relationship.

Patients with crossbites and/or deep bites can have anterior incisors inthe upper jaw and/or the lower jaw that are difficult to move into thedesired location because teeth in the opposing jaw are a physicalobstruction and therefore can prevent the desired movement from takingplace, in some instances. The repositioning jaw elements 106, 108 canprovide separation of the upper jaw from the lower jaw (e.g.,disclusion) by separating an occlusal surface of the first shell 114from an occlusal surface of the second shell 116. In various instances,the repositioning jaw elements 106, 108 used for the treatment ofcrossbites and deep bites can be the same buccal-lingual length and canextend from an occlusal, lingual, and/or buccal surface of the firstshell 114 and the second shell 116.

The repositioning jaw element 106, 108 can be positioned near posteriorteeth, for instance, to allow for an anterior portion of the bite of thepatient to open enough (e.g., disengage the occlusal interferences thatmay normally take place) to allow for easier treatment of the crossbiteand/or deep bite. For instance, the separation of occlusal surfaces canbe caused by preventing the cusp of the molars from sliding back intothe fossae on the opposing molars. In such situations, the upper jaw andthe lower jaw are held apart and avoid interfering with the prescribedtreatment, for example.

In accordance with a number of embodiments of the present disclosure, anopening of 5-6 millimeter (mm) at the first premolar region can bedesirable for treatment of deep bite, open bite, and/or othermalocclusions. For example, an aim of repositioning jaw elements totreat a patient with Class II, Division I deep bite can be to cause a 2mm inter-incisal clearance (e.g., space between the incisal teeth of theupper jaw and incisal teeth of the lower jaw) resulting in a 5-6 mmopening at the first premolar region (e.g., teeth). By contrast, an aimof repositioning jaw elements to treat a patient with Class II, DivisionII deep bite can be to cause 0 mm of inter-incisal clearance (e.g.,portions of the dental appliance with incisal teeth therein contact)resulting in a 5-6 mm opening at the first premolar region. Further, anaim of repositioning jaw elements to treat a patient with Class II, openbite can be to increase the inter-incisal clearance, as compared torepositioning jaw elements for Class II, Division 1 deep bite, resultingin a 5-6 mm opening at the premolar region. For example, in a 2 mmanterior open bite patient, a 4 mm inter-incisal clearance can beoptimal. In various embodiments, the repositioning jaw element 106, 108can inherently cause disclusion of posterior teeth of the patient.

The repositioning jaw elements 106, 108 interfacing, interacting, and/orengaging can be used to reposition a patient's lower jaw (e.g., lowerjaw 112 illustrated in the embodiment of FIG. 1A-1B) by placing a forceon the patient's jaw. The force can include a force on the jaws ofpatient for sagittal correction. The force can, for instance, sagittallymove the patient's lower jaw (e.g., in an anterior or posteriordirection) to reposition the patient's jaw.

In some embodiments, repositioning jaw elements, such as the firstrepositioning jaw element 106 and second repositioning jaw element 108,can include occlusal surfaces of the repositioning jaw elements thatsubstantially follow the contours of the occlusal surfaces of teeth onan opposing jaw of the patient (e.g., as illustrated in the embodimentof FIG. 12B). For instance, the occlusal surface (e.g., the top surface)of the first repositioning jaw element 106 can substantially follow thecontours of the occlusal surfaces of the posterior teeth of the lowerjaw (e.g., the occlusal surfaces of the posterior teeth of the lower jawthat the first repositioning jaw element 106 may contact). The occlusalsurface of the second repositioning jaw element 108 can substantiallyfollow the contours of the occlusal surfaces of the posterior teeth ofthe upper jaw (e.g., the occlusal surfaces of posterior teeth of theupper jaw that the second repositioning jaw element 108 may contact).Shaping the occlusal surfaces of repositioning jaw elements based on thepatient's dentition may, for instance, avoid interference between cuspsof teeth that may otherwise hit interferences in an opposing jaw whichcould increase the likelihood of unwanted tooth and/or jaw movements.

Alternatively and/or in addition, in some embodiments, occlusal surfacesof the repositioning jaw elements and/or other occlusal surfaces of theremovable dental appliance can have a geometry that differs from thecontours of the occlusal surfaces of teeth that are of an opposing jawof the patient (e.g., as illustrated in the embodiment of FIG. 10C). Forinstance, the geometry can include a pattern to match a new jaw position(e.g., forward or backward lower jaw position) of the patient (e.g., asdiscussed further herein).

In accordance with some embodiments of the present disclosure, aremovable dental appliance can include the first shell 114 and secondshell 116. The removable dental appliance can be configured toreposition a number of teeth of the patient's upper dentition and anumber of teeth of the patient's lower dentition concurrently withrepositioning of the patient's jaw. The simultaneous treatment ofmisalignment of a patient's jaw (e.g., Class II correction) inconjunction with teeth alignment issues (e.g., rotation, tipping, etc.)can shorten treatments times compared to sequential treatment protocolsthat first treat the misalignment of a patient's jaw before treating themisalignment of the patient's teeth. To help accomplish this objective,the repositioning jaw elements 106, 108, in accordance with a number ofembodiments, avoid and/or do not interfere with the engagement of theshell with the teeth contained therein.

The simultaneous treatment of misalignment of a patient's jawconcurrently with teeth misalignment can assist in the treatment ofrepositioning the patient's jaw. If untreated, teeth misalignment mayencourage occlusion in the original jaw position instead of the desiredjaw position (e.g., the intended or final jaw position), since theoptimal interdigitation between the arches coincides with the originaljaw position. Realignment of the teeth so that the teeth fit togetherbest in the desired jaw position can reinforce the desired jaw positionwhen the appliances are removed. Repositioning of the patient's jaw caninclude retraining the muscles associated with the movement of the lowerjaw. Due to the misalignment of a patient's teeth, a lower jaw of thepatient can be incorrectly positioned in a retruded position because theteeth position with the best fit may force the jaw into a more retrudedposition than physiologically comfortable. A treatment whereby the teethfit better in an anteriorly positioned mandible can relieve the jointcompression that may take place when the mandible is retruded. The jawmuscles of the patient can be retrained to hold the lower jaw in a moreforward (and more comfortable) position.

In contrast, the removable dental appliance embodiments discussed hereincan comprise a first shell 114, a second shell 116, a firstrepositioning jaw element 106 extending from a surface of the firstshell 114, and a second repositioning jaw element 108 extending from asurface of the second shell 116 and can concurrently treat misalignmentof the patient's jaw and misalignment of the patient's teeth. Concurrenttreatment can avoid and/or prevent reversion and/or retraining of themuscles in an incorrect position, among other benefits. Further,removable dental appliance embodiments, in accordance with the presentdisclosure, can result in fewer braces and/or elastics as compared toprior solutions. In growing patients, the concurrent treatment may alsoencourage growth of the jaw(s) in a more favorable direction.

Although the present embodiment of FIGS. 1A-1C illustrates repositioningjaw elements extending from an occlusal surface of a shell and/or nearan occlusal surface of one or more teeth of a patient, embodiments arenot so limited. The repositioning jaw elements, in some embodiments, canextend from a buccal surface, a lingual surface, an occlusal surface,and/or a combination thereof.

In some embodiments, the repositioning jaw elements (e.g., firstrepositioning jaw element 106 and second repositioning jaw element 108illustrated in FIG. 1C) can be hollow and/or can be filed with amaterial, such as a tooth colored material, a clear material, anacrylic, and/or a composite, among other materials, including materialsthat are printed via a three-dimensional (3D) printer or a through astereolithography process. The extra material can, for instance, provideadditional compressive strength as compared to a hollow repositioningjaw element.

In some embodiments, the hollow space within the repositioning jawelement can be used as a reservoir for the disbursement of medicationsor other items within the patient's mouth. For example, breathfreshening agents, medications to aid in moving of teeth and/orimprovement of the condition of the teeth and/or gums of the patient maybe provided therein and dispensed through holes and/or passages formedin the interior and/or exterior sides of the repositioning jaw element.

A hollow repositioning jaw element can increase the flexibility of theshell to which the repositioning jaw element is attached. The increasedflexibility introduced can lower the functionality and/or the retentionof the dental appliance in a vertical or horizontal direction. Forexample, as a patient moves to a fully engaged sagittal jaw position andthe repositioning jaw elements interface, the force placed on the shellcan result in a gingival line of the shell flaring (e.g., moving away)from the gum line of the patient. In a number of embodiments, a numberof design features and/or elements can be used to reduce and/oreliminate the increase in flexibility, such as grooves and curvedrepositioning jaw elements (e.g., as discussed further herein in regardsto the embodiment of FIG. 4, among other locations).

In some embodiments, the repositioning jaw elements can be shaped tominimize and/or prevent degrading the retention and/or functionality ofthe shell of the dental appliance. For example, the buccal-lingual widthof a repositioning jaw element can be different on an occlusal surfaceof the repositioning jaw element (e.g., top surface) than on abuccal-lingual width of a surface of the repositioning jaw elementadjacent to the shell (e.g., bottom surface). For instance, thebuccal-lingual width of a repositioning jaw element can be wider on anocclusal surface of the repositioning jaw element than on abuccal-lingual width of a surface of the repositioning jaw elementadjacent to the shell. Such a shape can be similar to the constructionof an I-beam, as illustrated in the embodiment of FIG. 12D, with thewider buccal-lingual occlusal surface interfacing with an occlusalsurface of a repositioning jaw element positioned on an opposing jaw.

In accordance with some embodiments of the present disclosure, therepositioning jaw elements can be positioned on the removable dentalappliance near unerupted and/or removed 2^(nd) and/or 3^(rd) molarteeth. Repositioning jaw elements positioned on the removable dentalappliance near the unerupted and/or removed 2^(nd) and/or 3^(rd) molarteeth can, for instance, provide increased area for tooth movements.Alternatively and/or in addition, a spring feature can be positioned onthe removable dental appliance near unerupted and/or removed 2^(nd)and/or 3^(rd) molar teeth. For example, a spring feature can bepositioned on a first removable dental appliance and a tab feature canbe positioned on a second removable dental appliance to interface withthe spring feature. The spring feature can guide the lower jaw of thepatient to a position (e.g., a forward or backward position), forexample (e.g., as illustrated in the embodiment of FIG. 9B).

In a number of examples, a variety of features can be used in additionto and/or in place of repositioning jaw elements to guide the lower jawto a position (e.g., a forward or backward position). Example featurescan include connecting the first shell and the second shell usingmaterial at posterior sides of the shells, a rigid structure, and/orridges, among other features (e.g., as illustrated in the embodiments ofFIGS. 11A and 11B, as discussed further herein).

FIG. 2A illustrates a side view of an upper jaw 202 with a firstrepositioning jaw element 206 and a lower jaw 204 with a secondrepositioning jaw element 208 according to a number of embodiments ofthe present disclosure. The upper jaw 202, the first repositioning jawelement 206, the lower jaw 204, and the second repositioning jaw element208 illustrated in FIG. 2A can include virtual images of jaws andrepositioning jaw elements, respectively (e.g., virtual jaws and/orvirtual repositioning jaw elements), as discussed further herein. Asillustrated in the embodiment of FIG. 2A, the first repositioning jawelement 206 can be positioned near a buccal surface of the posteriorteeth (e.g., molars and bicuspids) of the upper jaw 202 of the patientto move the position (e.g., to move sagittally) of the lower jaw 204 ina forward direction or backward direction.

Although not illustrated in FIG. 2A, the first repositioning jaw element206 can extend from a buccal surface of a first shell of a dentalappliance. A buccal surface of a shell, as used herein, can include anexterior surface of a shell near the buccal surface of the teeththerein. Further, in various embodiments, the first repositioning jawelement 206 can be positioned near a lingual surface of the first shell.A lingual surface of a shell can include an exterior surface of theshell near the lingual surface of the teeth therein.

The second repositioning jaw element 208 can be positioned near a buccalsurface of the posterior teeth (e.g., bicuspids) of the lower jaw 204 ofthe patient to move the position of the lower jaw 204 in a forwarddirection or backward direction. Although not illustrated in FIG. 2A,the second repositioning jaw element 208 can extend from a buccalsurface of a second shell of a dental appliance.

The first repositioning jaw element 206 and the second repositioning jawelement 208 can interface. For instance, a first surface 228 of thefirst repositioning jaw element 206 can interface with a second surface230 of the second repositioning jaw element 208. The first repositioningjaw element 206 and the second repositioning jaw element 208 can bepositioned to interface in a presence of a temporary bite (e.g., a fullyengaged sagittal jaw position of the patient's upper dentition and thepatient's lower dentition) in a manner to reposition the patient's jaw.A fully engaged sagittal jaw position, as previously discussed, caninclude a relationship of the mandible and the maxilla when the upperand lower jaw are closed as far as the dental appliance with therepositioning jaw elements will allow (e.g., a partial occlusal jawposition).

For example, the first surface 228 of the first repositioning jawelement 206 interfacing with the second surface 230 of the secondrepositioning jaw element 208 can place a force on the patient's jaw toreposition the patient's jaw. The force can, for instance, sagittallymove the patient's lower jaw 204.

In various embodiments, at least one of the repositioning jaw elements206, 208 can extend past an occlusal plane of the upper jaw 202 and/orlower jaw 204 of the patient. For example, the first repositioning jawelement 206 can extend past the occlusal plane of the upper jaw 202 tointerface with the second repositioning jaw element 208. The secondrepositioning jaw element 208 may not extend past the occlusal plane ofthe lower jaw 204, for instance. Alternatively, the second repositioningjaw element 208 can extend past the occlusal plane of the lower jaw 204to interface with the first repositioning jaw element 206 and the firstrepositioning jaw element 206 may not extend past the occlusal plane ofthe upper jaw 202. Further, in some embodiments, both the firstrepositioning jaw element 206 and the second repositioning jaw element208 can extend past the occlusal plane of the upper jaw 202 and thelower jaw 204, respectively, to interface with one another.

FIG. 2B illustrates a front view of an upper jaw 202 with a firstrepositioning jaw element 206 and a third repositioning jaw element 210and a lower jaw 204 with a second repositioning jaw element 208 and afourth repositioning jaw element 212 according to a number ofembodiments of the present disclosure. The upper jaw 202, the firstrepositioning jaw element 206, the third repositioning jaw element 210,the lower jaw 204, the second repositioning jaw element 208, and thefourth repositioning jaw element 212 illustrated in FIG. 2B can includevirtual images of jaws and repositioning jaw elements, respectively(e.g., virtual jaws and/or virtual repositioning jaw elements), asdiscussed further herein. As illustrated by FIG. 2B, two repositioningjaw elements (e.g., the first repositioning jaw element 206 and thethird repositioning jaw element 210) can be positioned near buccalsurfaces of the upper jaw 202 and two repositioning jaw elements (e.g.,the second repositioning jaw element 208 and the fourth repositioningjaw element 212) can be positioned near buccal surfaces of the lower jaw204.

For example, the first repositioning jaw element 206 can be positionednear the buccal surfaces of posterior teeth (e.g., molars and/orbicuspids) of the upper jaw 202 and the second repositioning jaw element208 can be positioned near the buccal surfaces of posterior teeth (e.g.,bicuspids) of the lower jaw 204. The first repositioning jaw element 206and the second repositioning jaw element 208 can be located near a firstposterior side of the patient's dentition (e.g., positioned on a firstposterior side of a first shell and a second shell).

The first repositioning jaw element 206 and the second repositioning jawelement 208 can include surfaces designed to interact, interface, and/orotherwise engage with one another. For instance, a first surface of thefirst repositioning jaw element 206 can interface with a second surfaceof a second repositioning jaw element 208. The first surface can includea slanted surface on a mesial-facing surface of the first repositioningjaw element 206 and the second surface can include a slanted surface ona distal-facing surface of the first repositioning jaw element 208, forexample.

The third repositioning jaw element 210 can be positioned near thebuccal surfaces of posterior teeth (e.g., molars and/or bicuspids) ofthe upper jaw 202 and the fourth repositioning jaw element 212 can bepositioned near the buccal surfaces of posterior teeth (e.g., bicuspids)of the lower jaw 204. The third repositioning jaw element 210 and thefourth repositioning jaw element 212 can be located near a secondposterior side of the patient's dentition (e.g., positioned on a secondposterior side of a shell of a first shell and a second shell).

The third repositioning jaw element 210 and the fourth repositioning jawelement 212 can include surfaces designed to interact, interface, and/orotherwise engage with one another. For instance, a third surface of thethird repositioning jaw element 210 can interface with a fourth surfaceof the fourth repositioning jaw element 212. The third surface caninclude a slanted surface on a mesial-facing surface of the thirdrepositioning jaw element 210 and the fourth surface can include aslanted surface on a distal-facing surface of the fourth repositioningjaw element 212, for example.

The surfaces of the repositioning jaw elements 206, 208, 210, 212 can beangled, in various embodiments, to guide the lower jaw 204 into theintended and/or final jaw position and/or prevent unwanted lateralmovement. The surfaces can be angled in buccal-lingual and/ormesial-distal direction. The angle of the surfaces (e.g., two surfacesthat are designed to interface) can be comprised of supplemental angles(e.g., have the same slants at the interface).

For example, the first surface of the first repositioning jaw element206 and the second surface of the second repositioning jaw element 208can interface at a first slant. The third surface of the thirdrepositioning jaw element 210 and the fourth surface of the fourthrepositioning jaw element 212 can interface at a second slant.

Although not illustrated by the embodiments of FIG. 2B, the firstrepositioning jaw element 206 can extend from a buccal surface of afirst shell of a dental appliance and/or the second repositioning jawelement 208 can extend from a buccal surface of a second shell of thedental appliance. The first repositioning jaw element 206 and the secondrepositioning jaw element 208 can be located near a first side of thepatient's dentition (e.g., the right side of the patient's dentition).The third repositioning jaw element 210 can extend from a buccal surfaceof the first shell of the dental appliance and the fourth repositioningjaw element 212 can extend from a buccal surface of the second shell ofthe dental appliance. The third repositioning jaw element 210 and thefourth repositioning jaw element 212 can be located near a second sideof the patient's dentition (e.g., a left side of the patient'sdentition).

In some embodiments, repositioning jaw elements can extend from alingual surface of the shells. A lingual surface of a shell can includean exterior surface of the shell near the lingual surface of the teeththerein. For example, in some embodiments, the first repositioning jawelement 206 and third repositioning jaw element 210 can each extend froma lingual surface of the first shell and the second repositioning jawelement 208 and fourth repositioning jaw element 212 can each extendfrom a lingual surface of the second shell. Positioning therepositioning jaw elements on the lingual surface of the shell can, forinstance, result in a dental appliance that is more aestheticallypleasing to the patient because the repositioning jaw elements are lessvisible to others (e.g., decreasing the prominence of the repositioningjaw elements).

Alternatively and/or in addition, a number of repositioning jaw elementscan extend from a lingual surface of the shells and a number ofrepositioning jaw elements can extend from a buccal surface of the shell(e.g., as illustrated by FIGS. 13A-13B). In such embodiments, the firstrepositioning jaw element 206, the second repositioning jaw element 208,the third repositioning jaw element 210, and the fourth repositioningjaw element 212 can each extend from a buccal surface of the first shelland the second shell. In addition, a fifth repositioning jaw element canextend from a lingual surface of the first shell and a sixthrepositioning jaw element can extend from a lingual surface of thesecond shell; a seventh repositioning jaw element can extend from alingual surface of the first shell and a eighth repositioning jawelement can extend from a lingual surface of the second shell. The fifthrepositioning jaw element and sixth repositioning jaw element can belocated near the first side of the patient's dentition and the seventhrepositioning jaw element and eight repositioning jaw element can belocated near the second side of the patient's dentition. Positioningrepositioning jaw elements on the lingual surface of the shells inaddition to the buccal surface of the shells can, for instance, provideadditional stability, decrease the aesthetic prominence of therepositioning jaw elements, and/or limit lateral movement, among otherbenefits.

In some embodiments, a plurality of repositioning jaw elements canextend from the buccal surface of the first shell and a plurality ofrepositioning jaw elements can extend from the buccal surface of thesecond shell. The plurality of repositioning jaw elements extending frombuccal surfaces can, for instance, decrease the prominence of therepositioning jaw elements as compared to a single repositioning jawelement extending from each buccal surface.

In accordance with a number of embodiments, a repositioning jaw elementextending from a buccal surface can be used to treat crossbite in apatient. For instance, a repositioning jaw element extending from abuccal surface of a first shell and a repositioning jaw elementextending from a buccal surface of a second sell can interface to tip amolar tooth in a buccal direction to treat crossbite in a patient.

FIG. 3 illustrates an example of a method 320 for separating an upperdentition from a lower dentition according to a number of embodiments ofthe present disclosure. Separating the upper dentition from the lowerdentition according to the method 320 can allow for treatment ofmalocclusions such as excessive or inadequate overjet, excessive orinadequate overbite, and/or crossbite, for instance.

At block 322, the method 320 includes moving at least one tooth with adental appliance having a first shell configured to receive a number ofteeth of a patient's upper dentition, the number of teeth comprising theat least one tooth. That is, the first shell can include a shellconfigured to receive a number of teeth of the patient's upper dentitionand reposition at least one tooth of the number of teeth of thepatient's upper dentition.

At block 324, the method 320 includes separating a patient's upperdentition from the patient's lower dentition utilizing the dentalappliance. For instance, the separation can include separating theocclusal surfaces to a threshold distance to prevent an occlusal surfaceof the first shell from contacting an occlusal surface of a secondshell. The second shell can include a shell configured to receive anumber of teeth of the patient's lower dentition and reposition at leastone tooth of the number of teeth of the patient's lower dentition.

The dental appliance, at block 326, can interface a first surface of afirst repositioning jaw element of the first shell with a second surfaceof a second repositioning jaw element of a second shell of the dentalappliance. The second shell can, for instance, be configured to receivea number of teeth of the patient's lower dentition. The dental appliancecan separate occlusal surfaces of the number of teeth of the patient'supper dentition from the occlusal surfaces of the number of teeth of thepatient's lower dentition as the patient moves to a fully engagedsagittal jaw position, for example. The surface area of therepositioning jaw elements that engage the upper jaw/shell to the lowerjaw/shell while the disengaged areas are separated may be built so thatthe engagement is a better fit than the existing occlusion (e.g.,greater points or surfaces in contact) so that the preferred position ofthe patient is the engaged surface area instead of the currentocclusion.

A sagittal jaw position can include a relationship of the mandible andthe maxilla when the upper jaw and the lower jaw are closed and theteeth are in contact. A fully engaged sagittal jaw position, as usedherein, can include a relationship of the mandible and the maxilla whenthe upper and lower jaw are closed as far as the dental appliance withthe repositioning jaw elements will allow (e.g., as the first surface ofa first repositioning jaw element interfaces, interacts, and/or engagesthe second surface of the second repositioning jaw element). That is, ina fully engaged sagittal jaw position, at least some of the teeth of theupper jaw and at least some of the teeth of the lower jaw are not incontact. Further, in some embodiments, at least some of the occlusalsurface of the first shell and the occlusal surface of the second shellare not in contact in a fully engaged sagittal jaw position.

As previously discussed, the fully engaged sagittal jaw position may beneeded in the treatment of malocclusion such as excess or insufficientoverjet, excess or insufficient overbite, and/or crossbite. Forinstance, separating the occlusal surfaces can allow for moving a lowerjaw of the patient or opening up the bite to a desired range of jawopening extending from the current position of occlusion. It can alsoallow for decompression of a lower jaw forward from an undesirablebackwards position into a more comfortable (and esthetically pleasing)anteriorly displaced position. The advancement can be unilateral orbilateral.

In a number of embodiments in accordance with the present disclosure,the occlusal surfaces can be separated to a threshold distance toprevent an occlusal surface of the first shell from contacting anocclusal surface of the second shell. An example threshold distance canbe one millimeter, however, a treatment professional may determineanother suitable distance and such distances are within the scope of theembodiments of the present disclosure.

In various embodiments, the method 320 can include separating theocclusal surfaces of the number of teeth the patient's upper dentitionfrom the occlusal surfaces of the number of teeth of the patient's lowerdentition as the patient moves to the fully engaged sagittal jawposition in a plurality of incremental distances utilizing a pluralityof dental appliances. For example, the repositioning jaw elements can bedesigned to incrementally treat a malocclusion, such as excessive orinadequate overjet, excessive or inadequate overbite, and/or crossbiteby using repositioning jaw elements provided on a plurality of dentalappliances. In some embodiments, the increment can include a gradualmovement (e.g., sagittal movement) of the lower jaw by shifting theposition of the repositioning jaw elements and/or shifting the length ofone or more repositioning jaw elements on each of a series of theplurality of dental appliances (e.g., as discussed further herein withregard to FIG. 7).

FIGS. 4A-4C illustrate examples of repositioning jaw elements accordingto a number of embodiments of the present disclosure. FIG. 4Aillustrates an example of two repositioning jaw elements 406, 408. Thetwo repositioning jaw elements 406, 408 can be virtual repositioning jawelements and/or physical repositioning jaw elements. The firstrepositioning jaw element 406 can include a first repositioning jawelement positioned on a first shell of the dental appliance. The secondrepositioning jaw element 408 can include a second repositioning jawelement positioned on a second shell of the dental appliance.

As illustrated by FIG. 4A, the first repositioning jaw element 408 caninclude a first surface 428 and the second repositioning jaw element 408can include a second surface 430. The first surface 428 can be a slantedsurface on a mesial-facing surface of the first repositioning jawelement 406 and the second surface 430 can be a slanted surface on adistal-facing surface of the second repositioning jaw element 408. Thesurfaces 428, 430 can interface at the slant (e.g., the angledsurfaces), for instance.

In a number of embodiments, a repositioning jaw element can include acurved back surface. For instance, a back surface (a surface on theopposite side relative to the surface that is designed to interface,interact, and/or engage a repositioning jaw element on an opposing jaw)of a repositioning jaw element can be curved in a distal direction. Asillustrated by FIG. 4A, the back surface of the first repositioning jawelement 406 is curved in a distal direction. The curving can, forinstance, improve comfort for a patient due to the reduction in sharpsurfaces exposed to the tongue and/or other soft tissues of the mouth.

FIG. 4B illustrates an example of a repositioning jaw element 434according to a number of embodiments of the present disclosure. Therepositioning jaw element 434 can include a virtual repositioning jawelement and/or a physical repositioning jaw element, for instance. Therepositioning jaw element 434 can include four side surfaces 436, 438,458 (e.g., the remaining side surface is facing away from the view). Thefirst side surface 436 can include a surface that can interface,interact, and/or engage with another surface of a repositioning jawelement on a shell of an opposing jaw. As illustrated, the first sidesurface 436 can be slanted. The second side surface 438 can include aback surface that is curved. For instance, the second side surface 438can be curved in a distal direction to improve comfort for the patient.

As illustrated by FIG. 4B, in various embodiments, a repositioning jawelement 434 can include a groove 440 on a top surface 452 of therepositioning jaw element 434. For instance, a reinforcement grooveand/or guide groove can be placed on a top surface 452 of a virtualand/or physical repositioning jaw element. The top surface 452 of arepositioning jaw element, as used herein, can include a surface of therepositioning jaw element extending toward an occlusal and/or coronalsurface of teeth on an opposing side of the patient's jaw. A groove, asused herein, can include a hollow channel within a repositioning jawelement. The groove 440 on the top surface 452 of the repositioning jawelement 434 can extend in a horizontal direction (e.g., a mesial-distaldirection), for instance.

Alternatively and/or in addition, in a variety of embodiments, arepositioning jaw element 434 can include a side groove on a buccal sidesurface and/or a lingual side surface (e.g., side surface 458) of arepositioning jaw element 434. A buccal side surface of a repositioningjaw element, as used herein, can include a side of the repositioning jawelement extending toward and/or adjacent to the cheek of the patient. Alingual side surface of the repositioning jaw element, as used herein,can include a side of the repositioning jaw element extending towardand/or adjacent to the tongue of the user. Grooves (e.g., a top grooveand/or number of side grooves) can, for example, increase a rigidity ofthe repositioning jaw element 434 as compared to a repositioning jawelement without grooves and/or can minimize and/or prevent degrading theretention and/or functionality of the shell of the dental appliance. Agroove can also function on the shell of each jaw during treatment.

In various instances, a plurality of side grooves 442-1, 442-2, 442-3,442-4, 442-5, 442-6 . . . 442-N) can be placed on the buccal sidesurface and/or the lingual side surface (e.g., side surface 458) of therepositioning jaw element 434. For example, the side grooves 442-1 . . .442-N can be placed on each of the buccal side surface and lingual sidesurface (e.g., side surface 458) of a virtual repositioning jaw elementand/or a physical repositioning jaw element. The side grooves 442-1 . .. 442-N can each include a hollow channel within the side surface of therepositioning jaw element 434. The side grooves 442-1 . . . 442-N canextend in vertical direction (e.g., an inferior-superior direction.) Asillustrated by FIG. 4B, in some embodiments, a repositioning jaw element434 can include a top groove 440 on a top surface 452 and side grooves442-1 . . . 442-N on side surfaces (e.g., side surface 458).

In some embodiments, the side grooves 442-1 . . . 442-N can includecoronal-apical grooves positioned at interproximal regions of at leastone of the number of teeth that the repositioning jaw element 434extends from. That is, each side groove can be placed at aninterproximal region of two teeth.

Although the present embodiment of FIG. 4B illustrates a top groove 440and a plurality of side grooves 442-1 . . . 442-N in a V-shape,embodiments in accordance with the present disclosure are not solimited. The grooves can include a variety of geometric shapes andsizes. For instance, the grooves can include portions of circles,hexagons, rectangles, and/or octagons, among other shapes and/or sizes.Geometric patterns may be used in lieu of grooves, so long as thepattern provides adequate structural rigidity that a groove or series ofgrooves may provide.

FIG. 4C illustrates an example of a repositioning jaw element 444according to a number of embodiments of the present disclosure. Therepositioning jaw element 444 can be a virtual repositioning jaw elementand/or a physical repositioning jaw element, for instance. Therepositioning jaw element 444 can include four side surfaces 436, 438,446 (the remaining side surface is facing away from the view). The firstside surface 436 can include a surface that can interface, interact,and/or engage with another surface. As illustrated, the first sidesurface 436 can be slanted. The second side surface 438 can include aback surface that is curved. For instance, the second side surface 436can be curved in a distal direction to improve comfort for the patient.Further, as illustrated by the repositioning jaw element 444 of FIG. 4C,the repositioning jaw element 444 can include a top groove 440 in thetop surface of the repositioning jaw element 444.

In accordance with some embodiments, a repositioning jaw element 444 caninclude curved side surfaces. For instance, a buccal side surface and/ora lingual side surface (e.g., side surface 446) can be curved in atleast one of a buccal and/or lingual direction. As illustrated by FIG.4C, the curved side surface 446 can include a bowed curve. For instance,the curved side surface 446 can result in the top surface of therepositioning jaw element 444 being shaped in a bone shape. A curvedside surface 446 can increase a rigidity of the repositioning jawelement 444 as compared to a non-curved side surface and/or can minimizeand/or prevent degrading the retention and/or functionality of the shellof the dental appliance, for example, by allowing greater surface areaof the shell to engage the teeth than if the side surfaces were notcurved.

FIGS. 5A-5C illustrate examples of repositioning jaw elements accordingto a number of embodiments of the present disclosure. FIGS. 5A-5Cillustrate an example of a repositioning jaw element. The repositioningjaw element can be a virtual repositioning jaw element and/or a physicalrepositioning jaw element, in various embodiments. For instance, FIG. 5Aillustrates a top-down view 550 of the repositioning jaw element. Thetop-down view 550 of the repositioning jaw element can include a view oftwo side surfaces with side grooves 542-1, 542-2, 542-3, 542-4, 542-5,542-6, 542-7, 542-8, 542-9 . . . 542-P, a surface that can interface,interact, and/or engage with another surface 536, a back surface 538,and a top surface 552.

In accordance with some embodiments, side surfaces can be beveled. Forinstance, the buccal side surface and lingual side surface with sidegrooves 542-1 . . . 542-P can be beveled to include a differentbuccal-lingual width on a bottom than a top of the side surfaces of therepositioning jaw element. For example, the buccal-lingual width on thebottom can be wider than the buccal-lingual width on the top of the sidesurfaces of the repositioning jaw element. In such embodiments, theocclusal surface of the repositioning jaw element can have a narrowerbuccal-lingual width than a surface of the repositioning jaw elementadjacent to and/or near the shell of the dental appliance (e.g., bottomsurface of the repositioning jaw element). Beveling of the side surfacescan, for instance, include beveling the surface 536 and/or the backsurface 538 to have a wider buccal-lingual width on the top than thebottom of the side surfaces (e.g., as discussed further with regard toFIG. 5B). Beveling the side surfaces 536, 538 and side grooves 542-1 . .. 542-P can, for example, assist in manufacturing the dental appliancewhere the appliance is built from a positive reference model (e.g., suchas a 3D printed model or stereolithography (SLA) model).

The repositioning jaw element illustrated in FIG. 5A can include aplurality of side grooves 542-1 . . . 542-P on a buccal side surfaceand/or a mesial side surface. Beveling the buccal side surface and/orlingual side surface can, for instance, include beveling the sidegrooves 542-1 . . . 542-P. For instance, the buccal-lingual width of thebottom of the side grooves 542-1 . . . 542-P (the surface adjacent toand/or near the shell) can be wider than the buccal-lingual width of thetop of the side grooves 542-1 . . . 542-P (the surface of the sidegrooves adjacent to and/or near the top surface 552 of the repositioningjaw element).

FIG. 5B illustrates a view 553 of the repositioning jaw element. Therepositioning jaw element of FIGS. 5A and 5B can include the same and/ordifferent repositioning jaw elements, in various instances. For example,FIG. 5B can include a view of repositioning jaw element illustrated inthe embodiment of FIG. 5A from the point of view of arrow 541.

The view 553 of the repositioning jaw element can include a view of thesurface that can interface, interact, and/or engage with another surface(e.g., the surface 536 of FIG. 5A). For instance, the surface caninclude a top adjacent to a top surface 552 of the repositioning jawelement, a bottom adjacent to a bottom surface 554 of the repositioningjaw element, and two sides adjacent to the buccal and/or lingual sidesurfaces 531-1, 531-2 of the repositioning jaw element.

As illustrated by FIG. 5B, the buccal-lingual width of the surface canbe beveled. For instance, the buccal-lingual width of the bottom of thesurface (e.g., adjacent to the bottom surface 554 of the repositioningjaw element) can be wider than the buccal-lingual width of the top ofthe surface (e.g., adjacent to the top surface 552 of the repositioningjaw element).

Further, as illustrated by the arrow 556, the surface that caninterface, interact, and/or engage with another surface can be slanted.For instance, the surface can be slanted at an angle in a mesial-distaldirection.

FIG. 5C illustrates an example side view 560 of a repositioning jawelement. The repositioning jaw element can be a virtual repositioningjaw element and/or a physical repositioning jaw element, in someembodiments. The repositioning jaw element of FIGS. 5A, 5B, and 5C caninclude the same and/or different repositioning jaw elements, in variousinstances. For example, FIG. 5C can include a view of repositioning jawelement illustrated in the embodiment of FIG. 5A from the point of viewof arrow 543. The side view 560 can include a view of a buccal and/orlingual side surface 558. The buccal and/or lingual side surface 558 caninclude a top adjacent to a top surface 552 of the repositioning jawelement, a bottom adjacent to a bottom surface 554 of the repositioningjaw element, a first side adjacent to the surface that can interface,interact, and/or engage with another surface 536 of the repositioningjaw element, and a second side adjacent to a back surface 538 of therepositioning jaw element. The buccal and/or lingual side surface 558,as illustrated by FIG. 5C, can include a plurality of side grooves.

As illustrated by FIG. 5C, repositioning jaw elements in accordance withthe present disclosure can include a slanted top surface. A slanted topsurface can include a slant in height from the surface 536 to the backsurface 538. For instance, the slant in height can include a highercoronal-apical height of a repositioning jaw element in a mesialdirection than a coronal-apical height of the repositioning jaw elementin a distal direction. Such a slant can, for instance, create a morecomfortable experience for the patient as the jaw of the patient may notclose in a flat direction (e.g., not parallel to a horizontal plane). Inother words, the vertical distance between the upper jaw and the lowerjaw may be greater in the anterior region than in the posterior regionfor some patients or greater in the posterior region than in theanterior region for others, depending on the original positioned and thedesired position (e.g., the intended and/or final position) of the jaw.By accommodating these variances, the patient may occlude in more points(and the temporary bite will be more stable) than if an even flat planewas designed into the temporary bite.

FIG. 6 illustrates an example computing device readable medium havingexecutable instructions that can be executed by a processor to perform amethod according to one or more embodiments of the present disclosure.For instance, a computing device 664 can have a number of componentscoupled thereto. The computing device 664 can include a processor 666and a memory 668. The memory 668 can have various types of informationincluding data 670 and executable instructions 672, as discussed herein.

The processor 666 can execute instructions 672 that are stored on aninternal or external non-transitory computer device readable medium(CRM). A non-transitory CRM, as used herein, can include volatile and/ornon-volatile memory. Volatile memory can include memory that dependsupon power to store information, such as various types of dynamic randomaccess memory (DRAM), among others. Non-volatile memory can includememory that does not depend upon power to store information.

Memory 668 and/or the processor 666 may be located on the computingdevice 664 or off the computing device 664, in some embodiments. Assuch, as illustrated in the embodiment of FIG. 6, the computing device664 can include a network interface 674. Such an interface 674 can allowfor processing on another networked computing device, can be used toobtain information about the patient, and/or can be used to obtain dataand/or executable instructions for use with various embodiments providedherein.

As illustrated in the embodiment of FIG. 6, the computing device 664 caninclude one or more input and/or output interfaces 678. Such interfaces678 can be used to connect the computing device 664 with one or moreinput and/or output devices 680, 682, 684, 686, 688.

For example, in the embodiment illustrated in FIG. 6, the input and/oroutput devices can include a scanning device 680, a camera dock 682, aninput device 684 (e.g., a mouse, a keyboard, etc.), a display device 686(e.g., a monitor), a printer 688, and/or one or more other inputdevices. The input/output interfaces 678 can receive executableinstructions and/or data, storable in the data storage device (e.g.,memory), representing a virtual dental model of a patient's dentition.

In some embodiments, the scanning device 680 can be configured to scanone or more physical dental molds of a patient's dentition. In one ormore embodiments, the scanning device 680 can be configured to scan thepatient's dentition and/or dental appliance directly. The scanningdevice 680 can be configured to input data into the computing device664.

In some embodiments, the camera dock 682 can receive an input from animaging device (e.g., a 2D or 3D imaging device) such as a digitalcamera, a printed photograph scanner, and/or other suitable imagingdevice. The input from the imaging device can, for example, be stored inmemory 668.

The processor 666 can execute instructions to provide a visualindication of a treatment plan, a dental appliance, and/or arepositioning jaw element on the display 686. The computing device 664can be configured to allow a treatment professional or other user toinput treatment goals. Input received can be sent to the processor 666as data 670 and/or can be stored in memory 668.

Such connectivity can allow for the input and/or output of data and/orinstructions among other types of information. Some embodiments may bedistributed among various computing devices within one or more networks,and such systems as illustrated in FIG. 6 can be beneficial in allowingfor the capture, calculation, and/or analysis of information discussedherein.

The processor 666, in association with the data storage device (e.g.,memory 668), can be associated with the data 670. The processor 666, inassociation with the memory 668, can store and/or utilize data 670and/or execute instructions 672 for placing virtual repositioning jawelements on a shell of a virtual model of a dental appliance. Such datacan include the virtual dental model. The virtual model of the dentalappliance with the repositioning jaw element can be used to create aphysical dental appliance, for instance, as discussed further herein.

The processor 666 coupled to the memory 668 can cause the computingdevice 664 to perform a method including, for example, providing avirtual model of a dental appliance having a shell configured toreposition a number of teeth of a patient. In various embodiments of thepresent disclosure, the processor 666 coupled to the memory 668 cancause the computing device 664 to perform the method includingpositioning a virtual repositioning jaw element on the shell of thevirtual model of the dental appliance parallel to a bite plane of thepatient, wherein the repositioning jaw element extends from a surface ofthe shell of the virtual model of the dental appliance.

For instance, to position the virtual repositioning jaw element parallelto a bite plane can include, in some embodiments, removing a virtualimage of the number teeth of the patient. With the teeth removed, avirtual representation of the bite plane of the patient can remain andthe virtual repositioning jaw element can be positioned parallel to thebite plane.

Further, in some embodiments, the processor 666 coupled to the memory668 can cause the computing device 664 to perform the method includingrevising the position of the virtual repositioning jaw element to alignwith a midline of at least one tooth of the number of teeth. Forinstance, in some embodiments, the virtual image of the number of teethcan be displayed (e.g., such as, after being removed) and the positionof the virtual repositioning jaw element can be automatically revised toalign with the midline of the at least one tooth that the virtualrepositioning jaw element extends from.

In some embodiments, the processor 666 coupled to the memory 668 cancause the computing device 664 to perform the method includingdetermining a degree of the patient's jaw alignment utilizing a virtualimage of the jaw of the patient. The virtual image of the jaw of patientcan include a virtual image of the mandible, its related soft and hardtissue, a number of teeth the patient's lower dentition, the maxilla,its related soft and hard tissues, and/or a number of teeth of thepatient's lower dentition. The degree of the patient's jaw alignment caninclude, for instance, a path of articulation or jaw opening andclosing. It may also include a repositioned location such as a protrudedposition, or a combination of semi-articulation and protrusion, forexample.

A dental appliance can be made, for example, by thermal-forming a sheetof plastic over a physical dental mold. The physical dental mold, forinstance, can represent an incremental position to which a patient'steeth are to be moved. The physical dental mold can be manufactured bydownloading a computer-aided Design (CAD) virtual dental model to arapid prototyping process, such as, for example, a computer-aidedmanufacturing (CAM) milling, stereolithography, and/or photolithography.The virtual dental mold can be hollowed out or “shelled” before sent formanufacturing to save on material cost, for example.

The dental mold (e.g., set of molded teeth) can be created from avirtual model of a number of teeth of a patient. A virtual model, forexample, can include an initial virtual dental model and/or intermediatevirtual dental model. A dental mold can be formed in accordance with aunique treatment file that identifies a patient, a stage of a treatmentplan, the virtual model of the number of teeth, and/or whether thedental mold is of the upper and/or lower dental arch.

In some embodiments, a treatment file can be accessed by a rapidprototyping apparatus machine, such as a SLA or 3D printing, to formand/or create the dental mold. The result of the dental mold can includea set of molded teeth. The set of molded teeth can include at least areplica of the number of teeth of the patient. The dental mold can beused to make a dental appliance, for example, by creating a negativeimpression of the dental mold using polymeric sheets of material andvacuum forming the sheets over the dental mold, as discussed above.

For instance, a dental appliance can be formed by layering athermoformable sheet of material and/or multiple sheets of one or morematerials over the dental mold. The materials can include a polymericmaterial, for instance. Generally, the dental appliance is producedand/or formed by heating the polymeric thermoformable sheet and vacuumor pressure forming the sheet over the dental mold (e.g., a number ofmolded teeth). The shape of the sheet of material can change thicknesson some portions of the sheet as it conforms to the mold shape. A dentalappliance can, for example, include a negative impression of the dentalmold. The appliance and/or parts thereof may be transparent,semi-transparent, or opaque in such a way as to emulate a nature toothshade.

However, embodiments in accordance with present disclosure are not solimited. For example, embodiments in accordance with the presentdisclosure can include forming a dental appliance utilizing a variety oftechniques, such as SLA or 3D printing, among other techniques.

In a number of embodiments, the processor 666 coupled to the memory 668can cause the computing device 664 to perform the method of providing atreatment plan. One or more appliances, including positioners,retainers, removable dental appliances, and/or other appliances forfinishing and maintaining teeth positioning, can be utilized by atreatment professional in performing a treatment plan. The treatmentplan can include the use of one or more dental appliances, as describedherein.

For example, the processor 666 coupled to the memory 668 can cause thecomputing device 664 to perform the method comprising identifying amisaligned jaw of a patient from a virtual image of the patient's jaw.The identification can include, for instance, determining a degree ofthe patient's jaw alignment utilizing the virtual image of the patient'sjaw.

For example, identifying a misaligned jaw of the patient can includeidentifying a plurality of jaw placements of the virtual model of thejaw between stages of the treatment plan. Each of the plurality of jawplacements can be identified in a range of stages (e.g., can beassociated with). A stage can include, for example, a predeterminedperiod of time of the treatment plan (e.g., 2 weeks). A range of stagesmay be helpful (e.g., required) to reposition the jaws according to atreatment time used (e.g., needed) to re-posture the mandible.

For instance, a first jaw placement can be associated with a first rangeof stages (e.g., a first stage to a third stage) of the treatment planand a second jaw placement can be associated with a second range ofstages (e.g., a fourth stage to a fifth stage). A jaw placement, as usedherein, can include a relation of the upper jaw and the lower jaw.

The first jaw placement, in some embodiments, can include a misalignedjaw of the patient and the second jaw placement can include a correctedand/or ideal jaw position for the patient (as discussed further herein).In other embodiments, the first jaw placement and the second jawplacement can each include a misaligned jaw of the patient. Aspreviously discussed, the misaligned jaw can include a function of therelative positions of teeth and the mandible and maxilla, either ofwhich may be retruded or protruded relative to the corrected and/orideal jaw position. The jaw placement can be different for each range ofstages but consistent within a range of stages.

A misaligned jaw can be repositioned in the range of stages in a singlejaw movement or multiple jaw movements to reposition the jaw. Forexample, a misaligned jaw can be repositioned to a corrected jawposition. The corrected jaw position can be accomplished in one or morejaw movements in the range of stages.

As an example, a 4 mm jaw reposition can be accomplished in a single jawmovement across twelve stages of a treatment plan (e.g., six months).Dental appliances associated with the twelve stages can include the samerepositioning jaw elements designed to move the jaw toward the 4 mmcorrected jaw position. However, as further discussed herein, theposition and/or orientation of the repositioning jaw elements betweenstages can be adjusted based on differences in tooth positions and/orjaw relation of the patient.

By contrast, a 6 mm jaw reposition can be accomplished in two 3 mm jawmovements across sixteen stages of a treatment plan (e.g., eightmonths). Dental appliances associated with the first through eightstages of the sixteen stages can include a first set of repositioningjaw elements designed to move the jaw toward a 3 mm corrected jawposition. Dental appliances associated with the ninth through sixteenthstage of the sixteen stages can include a second set of repositioningjaw elements designed to move the jaw from the 3 mm corrected jawposition toward the 6 mm corrected jaw position (e.g., 3 mm additionaljaw movement).

As further discussed herein, the first set of repositioning jaw elementscan include the same repositioning jaw elements with adjustments to theposition and/or orientation of the repositioning jaw elements betweenstages based on differences in tooth positions and/or jaw relation ofthe patient. Similarly, the second set of repositioning jaw elements caninclude the same repositioning jaw elements with adjustments to theposition and/or orientation of the repositioning jaw elements betweenstages based on differences in tooth positions and/or jaw relation ofthe patient.

In accordance with a number of embodiments of the present disclosure, afirst jaw movement for a patient can be greater than a threshold jawmovement. A first jaw movement, as used herein, can include a first jawmovement of a plurality of jaw movements or the only jaw movement of atreatment plan for a patient. For example, a threshold jaw movement caninclude a 2 mm and/or a 3 mm jaw movement.

A threshold jaw movement may be used to stimulate correction of the jawposition of the patient. If the first jaw movement is less than thethreshold jaw movement, the movement of the jaw of the patient may notstimulate correction of the jaw position.

A jaw movement after the first jaw movement, in some embodiments, can beless than the threshold jaw movement. For example, a jaw movement thatis less than the threshold jaw movement can be more comfortable for thepatient.

Alternatively, the jaw position of the patient can be moved using aplurality of incremental jaw movements (e.g., small increments) acrossthe range of stages. The incremental jaw movements can, for instance, beacross the range of stages to move the jaw of the patient toward thecorrected jaw position. Each incremental jaw movement can be a movementthat is less than the threshold jaw movement. For example, each jawmovement can include a 0.5 mm jaw movement per stage (or a number ofstages) of the range of stages.

Embodiments in accordance with the present disclosure are not limited tothe number of jaw placements, the number of stages in a range and/or thenumber of stages of a treatment plan illustrated by the present example.For instance, embodiments can include more or fewer jaw placements,stages in a range, or stages than discussed. Further, more than one ofthe identified jaw placements can include a misaligned jaw.

In some embodiments, the processor 666 coupled to the memory 668 cancause the computing device 664 to perform the method comprisingproviding a treatment plan for the patient. The treatment plan caninclude a virtual model of a dental appliance having a first shell and asecond shell configured to reposition at least one tooth of the patient.The at least one tooth can, for instance, include a tooth on a lower jawand/or a tooth on an upper jaw of the patient. Further, the virtualmodel of the dental appliance can include repositioning jaw elements onthe first shell and the second shell configured to move a position ofthe misaligned jaw of the patient (e.g., to move sagittally a positionof the misaligned jaw of the patient).

The repositioning jaw elements on the first shell and the second shellcan be designed based on an aim of repositioning the misaligned jaw ofthe patient. A particular repositioning jaw element can have a shape andangle specific to a treatment plan based on at least one of a finaland/or intended jaw position, an intended use (e.g., Class I correction,Class II correction, and/or Class III correction), and/or an orientationof a tooth over which the repositioning jaw element is positioned.

According to a number of embodiments of the present disclosure,providing a treatment plan for the patient can include identifying afinal jaw position of the patient. The final jaw position of the patientcan include, for instance, an improved and/or optimized jaw position.For instance, the final jaw position may include simultaneous contactingof the upper and lower teeth on the right and left sides, and in theanterior and posterior occlusal areas with maximum interdigitation, abest fit or seating of the condyles of the mandible within the jointhousing of the temporal bone, and/or correction of malocclusions.

The identified final jaw position can be used to design the virtualrepositioning jaw elements. For instance, the virtual repositioning jawelements can be designed to move the position of the misaligned jaw ofthe patient toward and/or to the final jaw position (e.g., to movesagittally).

Alternatively and/or in addition, a plurality of dental appliances(e.g., a series of dental appliances) can be used to move the positionof the misaligned jaw of the patient toward and/or to the final jawposition. For example, in some embodiments, providing the treatment plancan include providing a virtual model of a plurality of dentalappliances. The plurality of dental appliances can be configured toreposition the misaligned jaw in incremental distances according to anumber of stages of a treatment plan (e.g., as discussed further withregard to the embodiments illustrated in FIGS. 7A-7D).

The shape and angle of each of the repositioning jaw elements can bespecific to a stage of a treatment plan for which the appliance wasdesigned (e.g., successive appliances created according to a treatmentplan may have differently positioned, angled, and/or shapedrepositioning jaw elements). Repositioning jaw elements that have shapesand angles specific to particular stages of treatment can beadvantageous over using generic and/or uniform repositioning jaw elementthat are not specific to treatment stages and therefore may notaccurately provide the desired correction for the treatment stage duringwhich they are used. Such inaccurate treatment can lead to lengtheningtreatment plans, a need for a revised treatment plan, and/or unnecessaryuser discomfort, among other drawbacks. In contrast, a number ofembodiments of the present disclosure allow for more timely, accurate,and/or comfortable execution of treatment plans.

In various embodiments, the processor 666 coupled to the memory 668 cancause the computing device 664 to perform the method comprisingvirtually testing the jaw movement to occur by the patient wearing thedental appliance. The virtual testing can include testing jaw movement,in addition to movement of teeth, in a number of embodiments. Thevirtual repositioning jaw elements can be adjusted based on the virtualtesting of the jaw movement. For instance, the virtual repositioning jawelements can be adjusted to reach an intended jaw position and/or afinal jaw position in a treatment plan. The virtual testing and/oradjustment, in some embodiments, can be across a number of stages of atreatment plan.

For example, for each stage of a treatment plan, the instructions can beexecuted to model forces applied to a virtual model of the jaw by anappliance corresponding to that stage (to simulate actual forces to beapplied to a user's physical jaw by a physical appliance). Those forcescan include forces applied to the virtual model of the jaw by thevirtual repositioning jaw elements, by virtue of the appliance beingslightly out of alignment with a current configuration of the virtualmodel of the teeth and/or include forces applied to the aligner by theuser (e.g., when the user wears the physical dental appliance).

The instructions can be executed to position the virtual repositioningjaw elements on the digital teeth of the virtual model of the jaw at aparticular stage of treatment and/or adjust a position of the virtualrepositioning jaw elements for subsequent stages of treatment. Thevirtual model of the jaw can be different at each stage of treatmentaccording to the treatment plan (e.g., positioning of the virtual teethand/or jaw can change). The instructions can be executed to adjust theposition of the virtual repositioning jaw elements according to changesto the virtual model of the jaw between treatment stages and/oraccording to anticipated changes in subsequent stages of treatment(e.g., to help effectuate a desired change to the virtual model of thejaw).

Positioning and/or adjustment of positioning of virtual repositioningjaw elements on a virtual model of a jaw can be automatic (e.g., byoperation of software based on force modeling for a particular stage oftreatment), manual (e.g., by operation of an operator interacting withthe virtual model via an interface with a computing device), or acombination thereof. Likewise, the shape, size, orientation (e.g.,various angles with respect to references), and/or attachment location(on the virtual teeth) of the virtual repositioning jaw elements can beautomatically set by the software, by manual operation (e.g., anoperator can specify the necessary criteria of the virtual repositioningjaw elements and/or modify default criteria provided by the software),or a combination thereof.

An automatic positioning of virtual repositioning jaw elements on thevirtual model of the jaw can, for example, occur in response toidentifying the plurality of jaw placements of the virtual model of thejaw between stages of the treatment plan, as previously discussed. Theposition may be guided in part based on a posturing of the patient's jawin a simulated advanced position, whereby the postured position iscaptured and/or an input by means of a bite registration that can bephysical (e.g., wax or silicon bite) or digital (e.g., intraoral bitescan). Further, in some embodiments, the simulated advanced position maybe based on photographs of the patient when the patient's jaw is in theadvanced position. At least one of the plurality of jaw placements canbe identified as a misaligned jaw, wherein the jaw placement isassociated with a range of stages of the treatment plan.

A virtual model of a dental appliance having a first shell and a secondshell can be provided for at least one stage of the range of stages withthe identified misaligned jaw. Although embodiments are not so limitedand embodiments in accordance with the present disclosure can includeproviding a treatment plan that includes virtual models of dentalappliances (e.g., shells) for each stage of the treatment plan.

Virtual repositioning jaw elements can be positioned on the virtualteeth and/or virtual shells at the stage. For example, virtualrepositioning jaw elements can be positioned on shells of a first and alast stage of the range of stages with an identified misaligned jaw. Theposition at the first and the last stage of the range of stages caninclude an estimated initial repositioning jaw element position andorientation.

The positioned repositioning jaw elements can be refined at intermediatestages of the range of stages (e.g., between the first and the laststage of the range of stages). For example, the position at the firstand the last stage of the range of stages can be interpolated with arefined position and orientation at the intermediate stages. Thepositions at the first stage, last stage, and/or intermediate stages canbe adjusted (to a refined position and orientation) to comply with anumber of constraints, as discussed below. The refined position andorientation can include an optimized placement of the virtualrepositioning jaw elements.

That is, repositioning jaw elements for a first jaw placement that isassociated with a number of stages can be the same repositioning jawelements for each stage in the range of stages and/or can includeincremental adjustments between stages. For example, the incrementaladjustments can be based on differences in tooth positions and/or jawposition between stages.

Each repositioning jaw element within the range of stages can have asimilar gross movement (e.g., move toward a corrected jaw position) withrefined position and/or oriented (e.g., refined alignment with archcurve, refined angle of interface, etc.) based on the tooth placementand/or jaw position in the stage. The interpolation between stages cansmooth the transition of the repositioning jaw elements between stageswithin the same range of stages.

As previously discussed, the dental appliances, in some embodiments, canreposition the teeth of the patient in parallel with jaw repositioning.In such embodiments, the stages of the treatment plan can be associatedwith tooth movement. For instance, movement of teeth of the patientacross the stages of the treatment plan can be designed prior to,consecutively with, and/or subsequently to the jaw repositioningplanning.

For example, movement of teeth of the patient toward a target positioncan be planned across a plurality of stages of the treatment plan. Priorto, consecutively with, and/or subsequently to planning the movement ofteeth, the jaw repositioning can be planned. As previously discussed, amisaligned jaw of a patient associated with a range of stages of thetreatment plan can be identified.

In some embodiments, during designing of the repositioning jaw elements,the movement of teeth can be revised based on and/or to allow formovement of the jaw. For example, the position of the patient's teethcan be revised to support the corrected jaw position and/or to allow formovement to the corrected jaw position. Thereby, the repositioning ofthe teeth can be planned in parallel with jaw repositioning planning.

As an example, the range of stages may be helpful because certaininterferences between the upper jaw and the lower jaw may first beeliminated (e.g., such as movement of one or more teeth) before a moreanterior position of the jaw of the patient is attained withoutsignificantly opening the bite.

The virtual dental appliance (e.g., virtual shells with the virtualrepositioning jaw elements) can be designed using a number ofconstraints. A constraint, as used herein, can include a physical limitor restriction of the physical dental appliance to satisfy.

For example, the number of constraints can include physical limitationsor restrictions of a placement and/or an orientation of therepositioning jaw elements in relation to a current tooth arrangement(e.g., surfaces of particular teeth, position of particular teeth,and/or the arch curve), a current jaw position, and/or a predictedcorrected jaw position of the patient. A current tooth arrangementand/or current jaw position, as used herein, can include a tootharrangement and/or jaw position of the patient at a particular stage ofthe treatment plan that the repositioning jaw elements are designed for.

The tooth arrangement and/or jaw position of the patient can, forexample, change from one stage to another. Repositioning jaw elementscan be positioned and/or oriented for a particular stage of a treatmentplan based on the tooth arrangement and/or jaw position of the patientat the particular stage. The repositioning jaw elements can be the samefor a range of stages of the treatment plan to accomplish a particularjaw movement. However, the position and/or orientation of therepositioning jaw elements can be adjusted (e.g., are different) betweenthe stages of the range.

The constraints can be used to optimize placement of the virtualrepositioning jaw elements. For instance, the constraints can each besatisfied, and/or satisfied to the greatest extent possible, to satisfythe greatest subset of the constraints.

For example, the virtual dental appliance can be designed by inputting acorrected jaw position of the patient and outputting repositioning jawelements that can result in and/or move the jaw toward the corrected jawposition. A corrected jaw position can include a corrected relation ofthe upper jaw and the lower jaw as compared to the current jaw positionof the patient, as previously discussed. In some embodiments, thecorrected jaw position can include an ideal jaw position. An ideal jawposition can include an optimal relation of the upper lower and lowerjaw. The corrected jaw position can, for instance, be predicted (e.g.,calculated) using patient data. For instance, the patient data caninclude articulation information and/or tooth data of the patient.

The position of the repositioning jaw elements can be adjusted to anideal fit of the repositioning jaw elements based on the number ofconstraints. An ideal fit of the repositioning jaw elements can be aposition and fit of the repositioning jaw elements that can repositionthe patient's jaw toward the corrected jaw position and/or minimizediscomfort for a patient, among other benefits.

In some embodiments, the number of constraints for repositioning jawelements that extend from an occlusal surface of the shells (e.g.,herein generally referred to as “occlusal repositioning jaw elements”)can include: 1.) a distance between an occlusal repositioning jawelement and a coronal surface of a tooth on the opposing jaw is greaterthan a threshold distance, 2.) a tooth surface of a tooth beneath anocclusal repositioning jaw element does not extend through a surface ofthe occlusal repositioning jaw element, 3.) an occlusal repositioningjaw element does not violate buccal-lingual borders of occlusal surfacesof the teeth beneath, 4.) an occlusal repositioning jaw element isaligned with an arch curve direction, 5.) a slant of interface of theocclusal repositioning jaw element is aligned with the occlusal planenormal, 6.) angulation of an occlusal repositioning jaw element in abuccal-lingual direction is limited, 7.) an occlusal repositioning jawelement is positioned from the 1^(st) molar to the 1^(st) bicuspid, 8.)at least one molar (e.g., 2^(nd) or 1^(st) molar) on the lower jaw isuncovered by an occlusal repositioning jaw element, among other possibleconstraints that may be utilized, and 9). a specific bite registrationconfiguration.

For example, the distance between an occlusal repositioning jaw elementand a coronal surface of a tooth on the opposing jaw being greater thana threshold distance can account for the thickness of the shells. Thethickness of the shells can contribute to the separation differencebetween jaws. As an example, the threshold distance can include at leasttwo times the thickness of the shell.

A tooth surface of a tooth beneath an occlusal repositioning jaw elementnot extending through a surface of the occlusal repositioning jawelement can prevent and/or minimize unwanted forces applied to a coronalsurface of teeth beneath the repositioning jaw elements. For instance,the teeth beneath the occlusal repositioning jaw elements and/or teethbeneath surfaces of the occlusal repositioning jaw elements (e.g.,surfaces that may be able to contact a surface of the shell on theopposing jaw, such as a plane of material discussed further inconnection with FIG. 15) may not extend through the occlusalrepositioning jaw element and/or surface. To prevent a tooth fromextending through a surface of the occlusal repositioning jaw element, asurface of the occlusal repositioning jaw element (such as, the plane ofmaterial) can extend across the coronal surface of the tooth beneath thesurface of occlusal repositioning jaw element.

Not violating a buccal-lingual border of teeth beneath an occlusalrepositioning jaw element can distribute jaw closing forces across theshell of the dental appliance. A buccal-lingual border of teeth beneathcan include a buccal or lingual edge of the coronal surface of a tooth.

For instance, to not violate a buccal-lingual border, an occlusalrepositioning jaw element can be centered across the buccal-lingualwidth of the occlusal surface of the shell. Alternatively and/or inaddition, a buccal-lingual width of the repositioning jaw element can berevised to center the repositioning jaw element across thebuccal-lingual width of the occlusal surface of the shell. This canallow for the occlusal repositioning jaw element to be supported by theocclusal surfaces of the teeth beneath the occlusal repositioning jawelement and assist with preventing jaw closing forces from causingdental appliance dislodgement or gingiva impingement.

An occlusal repositioning jaw element can be aligned with an arch curvedirection of a patient by aligning the distal-mesial length of theocclusal repositioning jaw element along the curve of the arch of thepatient. Aligning with the arch curve direction, in accordance withembodiments of the present disclosure, can include aligning thedistal-mesial length of the occlusal jaw element with the curve of thearch of the patient to a threshold degree (e.g., plus or minus athreshold degree.

Further, a slant of interface of the occlusal repositioning jaw elementcan be aligned with an occlusal plane normal by the slant of interfaceof the first surface and/or the second surface being within a thresholddegree of parallel (e.g., two degrees) to the occlusal plane normal ofthe patient. For example, the slant of interface of an occlusalrepositioning jaw element aligning with the occlusal plane normal caninclude the first surface and the second surface interfacing within athreshold degree (e.g., above or below a few degrees) of parallel to theocclusal plane normal.

An occlusal plane, as used herein, can include a direction that isdetermined based on the bite surface of a patient. As previouslydiscussed, an occlusal plane is parallel to the bite surface of theteeth. An occlusal plane normal is perpendicular to the occlusal plane(e.g., bite surface) of the teeth of the patient, for example.

Aligning with the occlusal plane normal can prevent the angle ofinterface between a first surface of a first occlusal repositioning jawelement and a second surface of a second occlusal repositioning jawelement from being too shallow to move and/or keep the jaw in a positionand too steep to be comfortable for the patient. For instance, a rangeof angles of the interface of the first surface and the second surfacedesigned to interface, interact, and/or otherwise engage relative to theocclusal plane normal can be used.

The angulation of an occlusal repositioning jaw element in abuccal-lingual direction can include a buccal or lingual angle of theposition of the occlusal repositioning jaw element when viewedposteriorly. Ideally, if the occlusal repositioning jaw element isviewed posteriorly, the occlusal repositioning jaw element is parallelto occlusal plane normal (e.g., the occlusal repositioning jaw elementis not and/or is minimally positioned/tilted in a buccal or lingualdirection). A range of buccal-lingual angulation can be used, forexample. Limiting the angle can distribute jaw closing forces evenlyamong the teeth beneath the occlusal repositioning jaw element and/orsurfaces of the occlusal repositioning jaw element.

The range of the positioning of the occlusal repositioning jaw elementscan be from the 1^(st) molar to the 1^(st) bicuspids. The 2^(nd) molarand canines can be uncovered by the occlusal repositioning jaw elements.For example, the 2^(nd) molars may not be accurately captured by animpression or scan such that it may be beneficial to not position arepositioning jaw element on the 2^(nd) molars.

Further, canines may be uncovered by the occlusal repositioning jawelements as canines are often moved in treatment planning. Not coveringthe canines with occlusal repositioning jaw elements can allow thecanines to be simultaneously moved with the jaw repositioning treatmentto decrease treatment time. And, in some cases, at least one molar canbe uncovered by the occlusal repositioning jaw elements for labelingpurposes for manufacturing (e.g., to mark with identificationinformation).

A specific bite configuration, as used herein, can include one or morespecific contacts between opposing teeth that are identified (e.g. aspecific desired cusp-tip to fossa relationship or incisal edge toopposing fossae contact area). For instance, with a specific biteconfiguration the jaws are separated a specified amount in order tointegrate the desired dental appliance features.

In a number of embodiments, the number of constraints for repositioningjaw elements that extend from an buccal or lingual surface of the shells(herein generally referred to as “buccal or lingual repositioning jawelements”) can include, for example: 1.) a distance between a buccal orlingual repositioning jaw element and a coronal surface of a tooth onthe opposing jaw is greater than a threshold distance, 2.) coronalsurface of a tooth supports a buccal or lingual repositioning jawelement, 3.) avoid undercut, 4.) minimize angulation in buccal orlingual direction, 5.) a buccal or lingual repositioning jaw element isaligned with an arch curve direction, 6.) a slant of interface of abuccal or lingual repositioning jaw element is aligned with occlusalplane normal 7.) a buccal or lingual repositioning jaw element ispositioned from the 1^(st) molar to the 1^(st) bicuspid, 8.) symmetry ofbuccal or lingual repositioning jaw elements on the left side and rightside of the jaw, and 9.) buccal or lingual repositioning jaw elementscrisscross when viewed posteriorly or anteriorly.

Similarly to occlusal repositioning jaw elements, the distance between abuccal or lingual repositioning jaw element and a coronal surface of atooth on the opposing jaw being greater than a threshold distance canaccount for the thickness of the shells. The thickness of the shells cancontribute to the separation difference between jaws in ananterior-posterior direction. As an example, the threshold distance caninclude at least two times the thickness of the shell.

The coronal surface of a tooth beneath a buccal or lingual repositioningjaw element can provide support for the buccal or lingual repositioningjaw element. The support by the tooth beneath can prevent and/orminimize flaring of the buccal or lingual repositioning jaw element in abuccal or lingual direction, respectively, that may occur with biting onthe dental appliance.

The undercut of the tooth beneath the buccal or lingual repositioningjaw element can be avoided to prevent and/or minimize hygienic issuesfor a patient and/or manufacturability of the dental appliance, amongother benefits. For instance, a buccal or lingual repositioning jawelement positioned in and/or near an undercut of a tooth can result in areceptacle for food or other debris to collect and can cause difficultyfor manufacturing.

The angle of a buccal or lingual repositioning jaw element in buccal orlingual direction, respectively, can be minimized (while being enough tocomply with constraint 9) to increase patient comfort. For instance, anincrease in the angle of the repositioning jaw element in a buccaldirection that extends from a buccal surface of a shell can increasecontact with a cheek and/or other tissue of the patient.

Similarly, a buccal or lingual repositioning jaw element can be alignedwith an arch curve direction of the patient to prevent and/or minimizethe buccal or lingual repositioning jaw element from protruding intotissue of the patient (e.g., cheeks or tongue tissue). Aligning with thearch curve direction can include positioning the buccal or lingualrepositioning jaw element as close as possible to the arch curvedirection of the patient.

The slant of interface of a buccal or lingual repositioning jaw element,similarly to an occlusal repositioning jaw element, can be aligned withan occlusal plane normal of the patient. A slant of interface of abuccal or lingual repositioning jaw element can be aligned with anocclusal plane normal of a patient by an angle of an interface of afirst surface of a first buccal or lingual repositioning jaw elementand/or a second surface of a second buccal or lingual repositioning jawelement being within a threshold degree of parallel to the occlusalplane normal of the patient (e.g., perpendicular to the occlusal planeof the patient). For example, the slant of interface of an buccal orlingual repositioning jaw element aligning with the occlusal planenormal can include the first surface and the second surface interfacingwithin a threshold degree (e.g., above or below a few degrees) ofparallel to the occlusal plane normal of the patient.

Aligning with occlusal plane normal can allow for the angle of interfaceof the first surface of the first buccal or lingual repositioning jawelement and the second surface of the second buccal or lingualrepositioning jaw element to be steep enough to move the position of thepatient's jaw but not too steep to be uncomfortable for the patient.

The range of the positioning a buccal or lingual repositioning jawelement can be from the 1^(st) molar to the 1^(st) bicuspids. Aspreviously stated, the 2^(nd) molar and canines can be uncovered by thebuccal or lingual repositioning jaw elements.

The positioning of buccal or lingual repositioning jaw elements on theleft side of the jaw with buccal or lingual repositioning jaw elementson the right side of the jaw can be symmetric to prevent and/or minimizeinterfacing buccal or lingual repositioning jaw elements on one side ofthe jaw but not the other (e.g., on the left side but not the right sideor the right side but not the left side). If the buccal or lingualrepositioning jaw elements are interfacing on one side and not theother, uneven loading of the temporomandibular jaw joint can occur,which can cause a temporomandibular joint disorder (TMJ).

Further, the buccal or lingual repositioning jaw elements crisscrossingwhen viewed from the posterior or the anterior can assist in positioningand/or holding the lower jaw in an ideal position (e.g., a corrected jawposition and/or a position toward a corrected jaw position). For a firstbuccal or lingual repositioning jaw element and a second buccal orlingual repositioning jaw element to crisscross, a sufficient angle (ina buccal or lingual direction) and coronal-apical height of the buccalor lingual repositioning jaw elements is present to move the position ofthe jaw.

FIGS. 7A-7D illustrate examples of a plurality of devices forrepositioning jaws according to a number of embodiments of the presentdisclosure. In some embodiments of the present disclosure, a pluralityof dental appliances can be used for treating misalignment of teeth of apatient and/or misalignment of the patient's jaw. For example, atreatment plan can be divided into multiple parts (also called stages)wherein dental appliances (in this case, an appliance having an uppershell and lower shell) are used in succession to move one or more of thepatient's teeth and/or jaw from an initial position to a targetposition. And, wherein specialized dental appliances can be designed foreach stage of treatment having cavities with particular dimensions andorientations in which teeth are placed to move one or more of the teethto a particular position during the particular stage of treatment and/orto move the jaw to a new position when the jaw is closed (e.g., to aidthe jaw in following a different path from an open to a closed positionto change the path from an initial path to a target path wherein thedifferent path results in a new position of the jaw when it is fullyclosed). Such a change in jaw path can be accomplished with one deviceor incrementally with several devices wherein the repositioning jawelements are in different positions and/or orientations with respect toeach other and/or the shell on which they are connected. Accordingly, asdiscussed above, each of the plurality of dental device appliances caninclude a treatment stage in an incremental treatment plan.

For example, the plurality of devices can include a series of dentalappliances designed to incrementally implement a treatment plan. Forinstance, the series of dental appliances can incrementally move aposition of the patient's jaw (when the jaw is viewed in its fullyclosed orientation) from stage to stage. The movement of the position ofthe jaw can include a revised position of the lower jaw of the patientrelative to the upper jaw of the patient. Each stage of the treatmentplan can move the position of the patient's jaw an incremental distance(e.g., 0.1 mm) from the previous position of the patient's jaw, asdiscussed further herein. From one stage to the next stage, the positionof the patient's jaw can progress toward a final or target jaw position.

The incremental movement of the patient's jaw can occur based on the useof repositioning jaw elements that have slightly different positions ororientations on the shells from stage to stage. For example, thepositioning of repositioning jaw elements extending from a first shelland/or second shell of a dental appliance can be revised from a firststage to a second stage. The revised positioning can include changing amesial-distal length and/or a mesial-distal placement of a repositioningjaw element from one stage (e.g., a first dental appliance) to a nextstage (e.g., a second dental appliance), as discussed further herein.

As used herein, a “first stage” does not necessarily mean the originalstage of a treatment plan, but is a relative term with respect to otherstages. For example, the “first stage” may be a second stage of a 50stage treatment plan, while the “second stage” may be a tenth stage ofthe 50 stage treatment plan, while the “third stage” may be a 30th stageof the 50 stage treatment plan, and the “fourth stage” may be a 40thstage of the 50 stage treatment plan.

The treatment plan may just treat the position of the jaw or, in someembodiments, the treatment of the position of the jaws can be combinedwith the movement of one or more teeth on one or both jaws. Forinstance, the series of dental appliances can be used to incrementally(e.g., in increments of 0.1 mm) move a position of a misaligned jaw of apatient. This can be beneficial as typical current jaw alignmenttechniques move a jaw in large increments, such as 0.5 mm or greater,which may cause discomfort to the patient, among other issues.

As discussed above, one or more of the series of dental appliances canalso be configured to reposition a number of teeth of the patient'sdentition. In some embodiments, one or more of the series of dentalappliances can be configured to reposition a number of teeth of thepatient's dentition simultaneously with moving a position of a jaw ofthe patient. An example series of dental appliances can include a firstdental appliance comprising a first shell having a first repositioningjaw element extending therefrom and a second shell having a secondrepositioning jaw element extending therefrom. The first dentalappliance can be associated with and/or a part of an initial stage of atreatment plan (e.g., a first stage). The first dental appliance can beconfigured to move a misaligned jaw of the patient to a firstincremental jaw position. Jaw positions can be compared when the jaw ispositioned in a similar open-closed position along its path. Forexample, a comparison can be made when the jaw is in a fully engagedsagittal jaw position. Alternatively, a comparison could be made atother positions of the repositioning jaw elements, for example, when therepositioning jaw elements first contact each other.

The series of dental appliances can include a second dental appliancecomprising a first shell having a first repositioning jaw elementextending therefrom and a second shell having a second repositioning jawelement extending therefrom. The second dental appliance can beassociated with and/or a part of a second stage of the treatment plan(e.g., a subsequent stage to the initial stage). The second dentalappliance can be configured to move the misaligned jaw of the patient toa second incremental position.

For example, the second dental appliance can move the misaligned jawbased on the first repositioning jaw element and the secondrepositioning jaw element having a second position specific to a secondstage of the treatment plan. In this manner, the movement induced by useof the repositioning jaw elements can be divided into increments whichmay allow the movement to be more precise, may allow for more complexmovements, and may allow for less discomfort to the patient.

A non-engaged sagittal jaw position, as used herein, can include aposition of the patient's upper jaw and lower jaw when the repositioningjaw elements of the first shell and the repositioning jaw elements ofthe second shell are not interfacing, interacting, and/or engaging(e.g., not touching). For instance, a non-engaged sagittal jaw positionmay include a position of the first shell and the second shell such thatthe repositioning jaw elements are not providing a force to move (e.g.,sagittally) the patient's jaw.

An engaged sagittal jaw position, as used herein, can include a positionof the patient's upper jaw and lower jaw when the repositioning jawelements of the first shell and the repositioning jaw elements of thesecond shell are interfacing, interacting, and/or engaging. For example,an engaged sagittal jaw position may include a position of the firstshell and the second shell such that the repositioning jaw elements areproviding a force to move (e.g., sagittally) the patient's jaw. Asdiscussed herein, in various embodiments, the dental appliance may movea jaw of the patient in one or more other directions in addition tosagittal movement.

Although the present embodiment illustrates two dental appliances in aseries of dental appliances, embodiments in accordance with the presentdisclosure are not so limited. Treatment plans can include a variety ofnumber of dental appliances, including more or less than two dentalappliances.

As discussed above, each treatment stage can include a gradual movementof a lower jaw of a patient. The increments can occur based on changesin the mesial-distal length of the repositioning jaw elements and/orshifts in placement of the repositioning jaw elements on the shell (e.g.shift at least one repositioning jaw element in a mesial or distaldirection).

For example, as illustrated in each embodiment of FIGS. 7A-7D, thetreatment plan can include a number of treatment stages. The embodimentsof FIGS. 7A-7D each illustrate two treatment stages. Each of thetreatment stages can include a removable dental appliance with a firstshell (e.g., first shell 714-1 of the first stage and first shell 714-2of the second stage of FIGS. 7A-7D, herein generally referred to as“first shell 714”) and a second shell (e.g., second shell 716-1 of thefirst stage and second shell 716-2 of the second stage of FIGS. 7A-7D,herein generally referred to as “second shell 716”).

Each first shell 714 can have a number of tooth apertures configured toreceive and reposition a number of teeth of a patient's upper dentitionand each second shell 716 can have a number of tooth aperturesconfigured to receive and reposition a number of teeth of the patient'slower dentition. A first repositioning jaw element (e.g., 706-1 of thefirst stage and 706-2 of the second stage of FIGS. 7A-7D, hereingenerally referred to as “first repositioning jaw element 706”) canextend from a surface the first shell 714 and can include a firstsurface. A second repositioning jaw element (e.g., 708-1 of the firststage and 708-2 of the second stage of FIGS. 7A-7D, herein generallyreferred to as “second repositioning jaw element 708) can extend from asurface the second shell 716 and include a second surface to interface,interact, and/or engage with the first surface of the firstrepositioning jaw element 706.

For instance, the first repositioning jaw element 706 and the secondrepositioning jaw element 708 of each dental appliance can be positionedto interface in the presence of a fully engaged sagittal jaw position ofthe patient's upper dentition and the patient's lower dentition in amanner to reposition the patient's jaw. For instance, the repositioningcan include a forward and downward movement of the patient's lower jaw(e.g., to sagittally move).

Each dental appliance in the treatment plan (e.g., at each treatmentstage) can be configured to reposition the number of teeth of thepatient's upper dentition and the number of teeth of the patient's lowerdentition and/or reposition of the patient's jaw. For instance, therepositioning of the patient's jaw can be incremental across the numberof treatment stages. An incremental reposition of the patient's jaw caninclude, for instance, gradual advancement of the lower jaw. Asdescribed further herein, the gradual advancement can be achieved byshifting the placement of at least one of the repositioning jaw elementsfrom a first stage (e.g., first dental appliance) to a second stage(e.g., second dental appliance) and/or changing the mesial-distal lengthof at least one of the repositioning jaw elements from a first stage toa second stage of the treatment plan.

The embodiments of FIGS. 7A-7D can illustrate repositioning jaw elements706, 708 oriented in a horizontal line. For instance, each horizontalline can represent a side view of (e.g., shells) a jaw pair (e.g., anupper jaw and a lower jaw). Although not illustrated by FIG. 7A-7D, therepositioning jaw elements 706, 708 can be positioned to extend from asurface of a shell 714, 716 that is shaped to substantially follow adental arch of a patient. As such, the left end points of each ofFigures of 7A-7D represent a posterior direction 745 and/or regions ofthe jaws (e.g., of the patient when the dental appliance is worn) andthe right end points of each of the FIGS. 7A-7D represent anteriordirections 747 and/or regions of the jaws (e.g., of the patient when theremovable dental appliance is worn). The repositioning jaw elements 706,708 extend from the surfaces of the shells.

FIG. 7A illustrates an example of a number of treatment stages toreposition a jaw of a patient in gradual advancements by changing amesial-distal length of a first repositioning jaw element. Changing amesial-distal length of a repositioning jaw element, as used herein, caninclude increasing or decreasing the length of the repositioning jawelement along a mesial-distal plane of teeth of the patient. Forinstance, the first treatment stage can include a first repositioningjaw element 706-1 that extends from a surface of a first shell 714-1configured to receive and reposition a number of teeth of a patient'supper dentition. A second repositioning jaw element 708-1 can extendfrom a surface of a second shell 716-1 configured to receive andreposition a number of teeth of the patient's lower dentition.

The mesial-distal length of the first repositioning jaw element 706-1and the second repositioning jaw element 708-1 can include particularlengths based on the first treatment stage. For instance, the length canbe based on an incremental distance of the particular treatment stage.Based on the mesial-distal lengths of the first repositioning jawelement 706-1 and the second repositioning jaw element 708-1 of thefirst treatment stage, the patient's jaw can be repositioned to a firstincremental position and/or distance.

In some embodiments, as illustrated by FIG. 7A-D, the firstrepositioning jaw elements 706 can include a longer mesial-distal lengththan the second repositioning jaw elements 708. In some instances, apatient may have posterior teeth on the lower jaw that have not yetfully erupted. The longer mesial-distal length of the firstrepositioning jaw elements 706 on the first shell 714 can minimizeand/or prevent the posterior teeth on the lower jaw from eruptingfarther than is desirable (e.g., super eruption) while still allowingthe posterior teeth to erupt.

A second treatment stage can include a first repositioning jaw element706-2 that extends from a surface of a first shell 714-2 configured toreceive and reposition a number of teeth of the patient's upperdentition. A second repositioning jaw element 708-2 can extend from asurface of a second shell 716-2 configured to receive and reposition anumber of teeth of the patient's lower dentition.

The mesial-distal length of the first repositioning jaw element 706-2 ofthe second treatment stage can be increased from the mesial-distallength of the first repositioning jaw element 706-1 of the firsttreatment stage. The increase in mesial-distal length can be based onthe incremental distance of the particular treatment stage. The changecan include, for example, a particular distance value x 791 (e.g.,increase by particular distance value x 791) in which the mesial surfaceof repositioning jaw element 706-2 is extended by a distance “x” in themesial direction. The second repositioning jaw element 708-2 of thesecond treatment stage can be the same mesial-distal length as thesecond repositioning jaw element 708-1 of the first treatment stageand/or can be increased, in various embodiments. Based on themesial-distal lengths of the first repositioning jaw element 706-2 andthe second repositioning jaw element 708-2 of the second treatmentstage, the patient's jaw can be repositioned to a second incrementalposition and/or distance.

FIG. 7B illustrates an example of a number of treatment stages toreposition a jaw of a patient in gradual advancements by changing amesial-distal length of a second repositioning jaw element. Forinstance, the first treatment stage can include a first repositioningjaw element 706-1 that extends from a surface of a first shell 714-1configured to receive and reposition a number of teeth of a patient'supper dentition. A second repositioning jaw element 708-1 can extendfrom a surface of a second shell 716-1 configured to receive andreposition a number of teeth of the patient's lower dentition.

The mesial-distal length of the first repositioning jaw element 706-1and the second repositioning jaw element 708-1 can include particularlengths based on the first treatment stage. The length can be based onan incremental distance of the particular treatment stage. Based on themesial-distal lengths of the first repositioning jaw element 706-1 andthe second repositioning jaw element 708-1 of the first treatment stage,the patient's jaw can be repositioned to a first incremental positionand/or distance.

A second treatment stage can include a first repositioning jaw element706-2 that extends from a surface of a first shell 714-2 configured toreceive and reposition a number of teeth of the patient's upperdentition. A second repositioning jaw element 708-2 can extend from asurface of a second shell 716-2 configured to receive and reposition anumber of teeth of the patient's lower dentition.

The mesial-distal length of the second repositioning jaw element 708-2of the second treatment stage can be increased from the mesial-distallength of the second repositioning jaw element 708-1 of the firsttreatment stage. The increase in mesial-distal length can be based onthe incremental distance of the particular treatment stage. The changecan include, for example, a particular distance value x 792 (e.g.,increase by distance value x 792) in which the mesial surface ofrepositioning jaw element 708-2 is extended by a distance “x” in thedistal direction. The first repositioning jaw element 706-2 of thesecond treatment stage can be the same mesial-distal length as the firstrepositioning jaw element 706-1 of the first treatment stage and/or canbe increased, in various embodiments. Based on the mesial-distal lengthsof the first repositioning jaw element 706-2 and the secondrepositioning jaw element 708-2 of the second treatment stage, thepatient's jaw can be repositioned to a second incremental positionand/or distance.

FIG. 7C illustrates an example of a number of treatment stages toreposition a jaw of a patient in gradual advancements by shifting amesial-distal placement (e.g., shift the placement of the repositioningjaw element in a mesial or distal direction) of the first repositioningjaw element. For instance, the first treatment stage can include a firstrepositioning jaw element 706-1 that extends from a surface of a firstshell 714-1 configured to receive and reposition a number of teeth of apatient's upper dentition. A second repositioning jaw element 708-1 canextend from a surface of a second shell 716-1 configured to receive andreposition a number of teeth of the patient's lower dentition.

The mesial-distal placement of the first repositioning jaw element 706-1and the second repositioning jaw element 708-1 can include a particularplacement adjacent to posterior teeth therein based on the firsttreatment stage. For instance, the placement can be based on anincremental distance of the particular treatment stage. Based on themesial-distal placement of the first repositioning jaw element 706-1 andthe second repositioning jaw element 708-1 of the first treatment stage,the patient's jaw can be repositioned to a first incremental positionand/or distance.

A second treatment stage can include a first repositioning jaw element706-2 that extends from a surface of a first shell 714-2 configured toreceive and reposition a number of teeth of the patient's upperdentition. A second repositioning jaw element 708-2 can extend from asurface of a second shell 716-2 configured to receive and reposition anumber of teeth of the patient's lower dentition.

The mesial-distal placement of the first repositioning jaw element 706-2of the second treatment stage can be shifted in a mesial direction fromthe mesial-distal placement of the first repositioning jaw element 706-1of the first treatment stage. The shift in mesial-distal placement canbe based on the incremental distance of the particular treatment stage.The shift can include, for example, a particular distance value x 793(e.g., shift in a mesial direction by a distance value of x 793). Thesecond repositioning jaw element 708-2 of the second treatment stage canbe the same mesial-distal placement as the second repositioning jawelement 708-1 of the first treatment stage and/or can be shifted, invarious embodiments. Based on the mesial-distal placements of the firstrepositioning jaw element 706-2 and the second repositioning jaw element708-2 of the second treatment stage, the patient's jaw can berepositioned to a second incremental position and/or distance.

FIG. 7D an example of a number of treatment stages to reposition a jawof a patient in gradual advancements by shifting a mesial-distalplacement of the second repositioning jaw element. For instance, thefirst treatment stage can include a first repositioning jaw element706-1 that extends from a surface of a first shell 714-1 configured toreceive and reposition a number of teeth of a patient's upper dentition.A second repositioning jaw element 708-1 can extend from a surface of asecond shell 716-1 configured to receive and reposition a number ofteeth of the patient's lower dentition.

The mesial-distal placement of the first repositioning jaw element 706-1and the second repositioning jaw element 708-1 can include a particularplacement adjacent to posterior teeth therein based on the firsttreatment stage. For instance, the placement can be based on anincremental distance of the particular treatment stage. Based on themesial-distal placement of the first repositioning jaw element 706-1 andthe second repositioning jaw element 708-1 of the first treatment stage,the patient's jaw can be repositioned to a first incremental positionand/or distance.

A second treatment stage can include a first repositioning jaw element706-2 that extends from a surface of a first shell 714-2 configured toreceive and reposition a number of teeth of the patient's upperdentition. A second repositioning jaw element 708-2 can extend from asurface of a second shell 716-2 configured to receive and reposition anumber of teeth of the patient's lower dentition.

The mesial-distal placement of the second repositioning jaw element708-2 of the second treatment stage can be shifted in a distal directionfrom the mesial-distal placement of the second repositioning jaw element708-1 of the first treatment stage. The shift in mesial-distal placementcan be based on the incremental distance of the particular treatmentstage. The shift can include, for example, a particular distance value x794 (e.g., shift in a distal direction by a distance value of x 794).The first repositioning jaw element 706-2 of the second treatment stagecan be the same mesial-distal placement as the first repositioning jawelement 706-1 of the first treatment stage and/or can be shifted, invarious embodiments. Based on the mesial-distal placements of the firstrepositioning jaw element 706-2 and the second repositioning jaw element708-2 of the second treatment stage, the patient's jaw can berepositioned to a second incremental position and/or distance.

Although the present embodiments of FIGS. 7A-7D illustrate two treatmentstages of a treatment plan, embodiments in accordance with the presentdisclosure are not so limited. Treatment plans can include a variety ofnumber of treatment stages, including more or less than two treatmentstages. At least a portion of the treatment stages can include treatmentfor gradual advancement of the patient's jaw. Further, one or more ofthe treatment stages may not include repositioning jaw elements, invarious embodiments.

FIGS. 8A-8D illustrate examples of repositioning jaw elements accordingto a number of embodiments of the present disclosure. FIG. 8Aillustrates, for instance, repositioning jaw elements 806, 808, 810, 812that include geometric features 851-1, 851-2, 851-3, 851-4 to engagewith a repositioning jaw element on an opposing jaw.

Geometric features 851-1 . . . 851-4, as used herein, can include avariety of protruding geometric shapes (e.g., cylinder, rectangular,etc.) and/or receding geometric shapes (e.g., negative space thatmatches the protruding geometric shape on a repositioning jaw element onan opposing jaw). For example, a geometric feature 851-1 on the firstsurface of the first repositioning jaw element 806 of a first shell 814can include a concave shaped feature and a geometric feature 851-2 onthe second surface of the second repositioning jaw element 808 of asecond shell 816 can include a convex shaped feature shaped to mate withthe geometric feature 851-1 on the first surface of the firstrepositioning jaw element 806.

Similarly, a geometric feature 851-3 on the third surface of the thirdrepositioning jaw element 810 of the first shell 814 can include aconcave shaped feature and a geometric feature 851-4 on the fourthsurface of the fourth repositioning jaw element 812 of the second shell816 can include a convex shaped feature shaped to mate with thegeometric feature 851-3 on the third surface of the third repositioningjaw element 810.

FIG. 8B illustrates a repositioning jaw element 803 on an occlusalsurface of a removable dental appliance. As illustrated, therepositioning jaw element 803 can be located on an occlusal surface of afirst shell 814 (e.g., an upper dentition).

The repositioning jaw element 803 can, for instance, include an occlusalsurface that has a geometry shaped to mate with the contours of theocclusal surfaces of the second shell 816. The mating can, for instance,be designed to reposition the jaw of the patient by guiding the lowerjaw of the patient into a forward position or backward position (e.g.,to move sagittally).

FIGS. 8C-8D illustrate example of repositioning jaw elements 806, 808with magnets within. Repositioning jaw elements 806, 808 with magnetswithin can extend from occlusal, buccal, and/or lingual surfaces ofshells 814, 816 of a removable dental appliance. The magnets within therepositioning jaw elements 806, 808 on opposing jaws can be oppositepoles and/or same poles to guide the lower jaw to a position. Forexample, opposite poles on magnets can be used to attract the lower jawinto the forward position and/or same poles on magnets can be used topush the lower jaw into the forward position.

FIG. 8C illustrates an example of repositioning jaw elements 806, 808with magnets within that have opposite poles on opposite jaws to attractthe lower jaw (e.g., the second shell 816) into the forward position. Incontrast, FIG. 8D illustrates an example of repositioning jaw elements806, 808 with magnets within that have same poles on opposite jaws topush the lower jaw (e.g., the second shell 816) into the forwardposition.

Although the embodiments of FIGS. 8C and 8D illustrate attracting orpushing the lower jaw into a forward position (e.g., Class IIcorrection), embodiments in accordance with the present disclosure arenot so limited. For example, embodiments in accordance with the presentdisclosure can include magnets within repositioning jaw elements thatattract or push the lower jaw into a backward position (e.g., Class IIIcorrection).

FIGS. 9A-9B illustrate examples of features of devices for repositioningjaws according to a number of embodiments of the present disclosure. Thedevices illustrated in FIGS. 9A-9C can include removable dentalappliances. FIG. 9A, for instance, illustrates an example repositioningjaw element 907 with a groove 953 on a first shell 914 and a geometricfeature 909 on a second shell 916.

The groove 953 of the repositioning jaw element 907 can include, forinstance, a hollow channel located within and/or on a surface of therepositioning jaw element 907 that is angled (e.g., a surface of therepositioning jaw element 907 that is designed to interface, interact,and/or engage with another repositioning jaw element and/or shell). Thegroove 953 can be shaped to mate with a geometric feature 909 on asecond shell 916 on an opposite jaw. The geometric feature 909 on thesecond shell 916 on the opposite jaw can include a cylinder shapedfeature that can rotate and/or slide down the angled surface of therepositioning jaw element 907 of the first shell 914 until the groove953 is reached. That is, the groove 953 can limit and/or stop movementof the geometric feature 909 on the second shell 916. The groove 953 andgeometric feature 909 combination can, for instance, allow for greaterfreedom of motion of the lower jaw while repositioning the lower jaw toa forward position or backward position.

In some embodiments, a first repositioning jaw element of a first shell914 and a second repositioning jaw element of a second shell 916 caninclude geometric features. For instance, geometric features of a firstrepositioning jaw element and/or a second repositioning jaw element caninclude a protrusion and a socket. For example, a first repositioningjaw element can include a protrusion extending from the firstrepositioning jaw element in a direction toward occlusal surfaces teethof the opposing jaw. The second repositioning jaw element can include asocket within the second repositioning jaw element. The protrusion ofthe first repositioning jaw element can fit into the socket of thesecond repositioning jaw element to assist in guiding the lower jaw intoa forward position or a backward position.

FIG. 9B illustrates an example of a device with a first geometricfeature 911 on a first shell 914 and a second geometric feature 913 on asecond shell 916. For instance, the second geometric feature 913 caninclude a spring feature positioned on the second shell 916 and thefirst geometric feature 911 can include a tab feature positioned on thefirst shell 914 to interface, interact, and/or engage with the springfeature (e.g., the second geometric feature 913). The spring featurecan, for instance, guide the lower jaw of the patient to a forwardposition or backward position, for example. For instance, the firstgeometric feature 911 interfacing, interaction, and/or engaging with thesecond geometric feature 913 can provide a force on the lower jaw of thepatient to move sagittally the position of the lower jaw.

FIGS. 10A-10C illustrate examples of occlusal features of devices forrepositioning jaws according to a number of embodiments of the presentdisclosure. The devices illustrated in FIGS. 10A-10C can includeremovable dental appliances.

FIG. 10A illustrates an example device with a plurality of ridges on theocclusal surfaces of the first shell 1014 and a plurality of ridges onthe second shell 1016. The ridges can be used to guide the lower jaw ofthe patient to a position, such as a forward position or a backwardposition. Ridges, as used herein, can include protrusions that extend ina coronal-apical direction and have a buccal-lingual width (e.g., 1 mm).The ridges on the first shell 1014 can protrude in an alternating orderas the ridges on the second shell 1016, for instance.

FIG. 10B illustrates an example of a device with a plurality of pairs ofmagnets within the occlusal surface of the first shell 1014 and thesecond shell 1016. The magnets within the occlusal surfaces of theshells 1014, 1016 on opposing jaws can be opposite poles and/or samepoles to guide the lower jaw to a forward position or backward position.The plurality of pairs of magnets can be used to distribute the forceevenly across the arch and/or across posterior teeth.

FIG. 10C illustrates an example of a device with occlusal surfaces thathave a geometry that differs from the contours of occlusal surfaces ofteeth that are on an opposing jaw of the patient. For instance, thegeometry of the occlusal surface of the first shell 1014 and thegeometry of the occlusal surface of the second shell 1016 can include apattern to match a forward lower or backward lower jaw position of thepatient. As illustrated by FIG. 10C, in some embodiments, the geometrycan be on occlusal surfaces of a device that does not includerepositioning jaw elements and the geometry can retrain the muscles ofthe lower jaw to be positioned in a forward lower jaw position or abackward lower jaw position (e.g., to move sagittally).

Further, in various embodiments, a dental appliance of the presentdisclosure can include one or more repositioning jaw elements having astructure to indicate to a patient that the patient has positioned thefirst and second repositioning jaw elements of the first shell andsecond shell in a fully engaged sagittal jaw position. For example, inthe embodiment of FIG. 10C, the points of the repositioning jawstructure 1016 will stop when they fully engage with the cooperatingvalleys of the opposing repositioning jaw structure 1014. Other examplesof these indicting type structures can be seen in various embodimentsillustrated in the figures such as, FIGS. 8A, 8B, and 12B.

FIGS. 11A-11B illustrate examples of devices for repositioning jawsaccording to a number of embodiments of the present disclosure. Thedevices illustrated in FIGS. 11A-11B can include removable dentalappliances.

In a number of examples, a variety of features can be used in additionto and/or in place of repositioning jaw elements to guide the lower jawto a position, such as a forward position or a backward position.Example features can include connecting the first shell and the secondshell using material at the sides of the shells in the posterior region,a rigid or flexible connecting structure (e.g., as illustrated by FIGS.11A and 11B), ridges (e.g., as illustrated by FIG. 10A), magnets (e.g.,as illustrated by FIG. 10B), and/or occlusal surfaces (e.g., asillustrated by FIG. 10C), among other features.

FIG. 11A illustrates an example of a device with a first shell 1114 anda second shell 1116 connected by a rigid or flexible connectingstructure 1121 to advance a lower jaw of the patient to a position, suchas a forward position or backward position (e.g., move a lower jaw ofthe patient or opening up the bite to a desired range of jaw openingextending from the current position of occlusion). The rigid or flexibleconnecting structure 1121 can form a hinge.

The rigid or flexible connecting structure 1121 can include a strip ofmaterial (e.g., an arm), such as metal, polymer, and/or other material,which can connect the first shell 1114 to the second shell 1116. Asillustrated by the embodiment of FIG. 11A, the rigid structure 1121 canbe connected to the first shell 1114 and the second shell 1116 in avariety of ways. In some embodiments, the rigid or flexible connectingstructure 1121 can be connected to the first shell 1114 and the secondshell 1116 using magnetic materials 1123-1, 1123-2, pins 1125-1, 1125,and/or similar features.

These features can allow the connecting structure to be easily installedand removed by the patient. For instance, the rigid or flexibleconnecting structure 1121 can form a hinge that uses magnetic materials1123-1, 1123-2, pins 1125-1, 1125, and/or similar features to hold thefirst shell 1114 and the second shell 116 together while allowing thefirst shell 1114 and the second shell 116 to rotate. When a patientplaces the first shell 1114 and the second shell 1116 over their teeth,the patient can place the rigid or flexible connecting structure 1121near the appropriate location. The magnetic materials 1123-1, 1123-2, insome embodiments, can snap the rigid or flexible connecting structure1121 into the appropriate location (e.g., from a close and/or nearappropriate location to the appropriate location). A wire can be placedon a lingual surface of the second shell 1116 (e.g., lower jaw) todistribute the load evening across the dental arch, in variousembodiments.

FIG. 11B illustrates an example of a device with a first shell 1114 anda second shell 1116 formed as a single piece. The first shell 1114(e.g., upper jaw) and the second shell 1116 (e.g., lower jaw) can beconnected into one piece to advance a lower jaw of the patient oropening up the bite to a desired range of jaw opening extending from thecurrent position of occlusion. For example, the first shell 1114 and thesecond shell 1116 can be connected by material 1129 at a right posteriorside and a left posterior side of the first shell 1114 and the secondshell 1116. The material 1129 can include the same and/or differentmaterial than the material of the first shell 1114 and the second shell1116, for instance. The material 1129 can be flexible to allow jawarticulation while continuing to provide positioning guidance to thejaws.

FIGS. 12A-12B illustrate examples of devices according to a number ofembodiments of the present disclosure. The repositioning jaw elements1206, 1208 of the devices illustrated in FIGS. 12A-12B can interface,interact, and/or engage with one another to move a position of apatient's jaw from a current position of occlusion to a target and/orfinal position of occlusion (e.g., to move sagittally).

FIG. 12A illustrates an example of a device with a first repositioningjaw element 1206 extending from a surface of a first shell 1214 and asecond repositioning jaw element 1208 extending from a surface of asecond shell 1216. The first repositioning jaw element 1206 and thesecond repositioning jaw element 1208 can interface, interact, and/orengage in the presence of fully engaged sagittal jaw position of apatient.

As illustrated by the embodiment of FIG. 12A, in a number ofembodiments, one or more of the repositioning jaw elements 1206, 1208can include a layer of compressible material 1231-1, 1231-2 on a surfacedesigned to interface, interact, and/or engage with anotherrepositioning jaw element. For example, the compressible material1231-1, 1231-2 can assist in guiding the lower jaw of a patient to aforward or backward position by being in a compressed state when thesurfaces are initially interfacing, interacting, and/or engaged, thenuncompressing to push the lower jaw forward or backward as the jawsrelax. That is, the compressible material 1231-1, 1231-2 can becompressed when the jaws of the patient initially move to a fullyengaged sagittal jaw position and, as the patient's jaws relax over aperiod of time, the compressive material 1231-1, 1231-2 can expand(e.g., increase in thickness from the compressed state) to push thelower jaw forward or backward.

FIG. 12B illustrates an example of a device with a first repositioningjaw element 1206 extending from a surface of a first shell 1214 and asecond repositioning jaw element 1208 extending from a surface of asecond shell 1216. In some embodiments, at least one of therepositioning jaw elements (e.g., the first repositioning jaw element1206 and the second repositioning jaw element 1208) can include occlusalsurfaces that substantially follow the contours of the occlusal surfacesof teeth on an opposing jaw of the patient.

For instance, as illustrated by the embodiment of FIG. 12B, the occlusalsurface (e.g., the top surface) of the first repositioning jaw element1206 can substantially follow the contours of the occlusal surfaces ofthe posterior teeth of the lower jaw (e.g., the occlusal surfaces of theposterior teeth of the lower jaw that the first repositioning jawelement 1206 may contact). The occlusal surface of the secondrepositioning jaw element 1208 can substantially follow the contours ofthe occlusal surfaces of the posterior teeth of the upper jaw (e.g., theocclusal surfaces of posterior teeth of the upper jaw that the secondrepositioning jaw element 1208 may contact). Shaping the occlusalsurfaces of repositioning jaw elements based on the patient's dentitionmay, for instance, avoid interference between cusps of teeth that mayotherwise hit interferences in an opposing jaw which could increase thelikelihood of unwanted tooth and/or jaw movements.

FIGS. 12C-12D illustrate examples of repositioning jaw elements 1206,1208 according to a number of embodiments of the present disclosure. Theupper jaw 1202, the first repositioning jaw element 1206, the lower jaw1204, and the second repositioning jaw element 1208 illustrated in FIGS.12C-12D can include virtual images of jaws and repositioning jawelements, respectively (e.g., virtual jaws and/or virtual repositioningjaw elements), and/or a physical mold. The virtual images and/orphysical mold of the jaws 1202, 1204 and repositioning jaw elements1206, 1208 can be used to determine a treatment plan for the patientand/or to form a physical dental appliance and/or physical repositioningjaw element.

FIG. 12C illustrates a side view of an upper jaw 1202 with a firstrepositioning jaw element 1206 and a lower jaw 1204 with a secondrepositioning jaw element 1208 according to a number of embodiments ofthe present disclosure. In a number of embodiments, one or moreattachment elements 1233-1, 1233-2, 1233-3, 1233-4, 1233-5 can bevirtually and/or physically attached to a surface of at least some ofthe virtual teeth, set of molded teeth, and/or physical teeth of apatient. The attachment elements 1233-1 . . . 1233-5 can be used tominimize and/or prevent degrading the retention and/or functionality ofthe shell of the dental appliance.

For instance, the attachment elements 1233-1 . . . 1233-5 can be addeddirectly to a buccal/facial and/or lingual surface of a patient's tooth.An attachment element, as used herein, can include an attachmentsub-device with a small base extending across a mesial-distal and/orincisal-gingival-crown surface of the tooth. The attachment elements1233-1 . . . 1233-5 can be bonded to any surface of the tooth (and bemade either indirectly (e.g. a light or chemical-cured dental composite)or directly (e.g. prefabricated plastic, composite, or porcelainobject)). An attachment element bonded to a lingual surface of a toothof the patient can be more aesthetically pleasing to a patient (and lessnoticeable to others than an attachment element bonded to abuccal/facial surface). The attachment elements 1233-1 . . . 1233-5 canalso be attached to at least some of the anchoring teeth. The attachmentelements 1233-1 . . . 1233-5 can include a variety of geometric shapes,such as ovoid, tear-drop, ramp, hexagonal, and/or rectangular, amongother shapes.

The one or more attachment elements 1233-1 . . . 1233-5 can be designedto work with a virtual model of a removable dental appliance and/or aphysical removable dental appliance. The shell can be shaped, forinstance, to be placed over the attachment element(s) 1233-1 . . .1233-5 to minimize and/or prevent vertical displacement of the shell.For example, the shell can include a ridge on the shell used to retainthe dental appliance on the teeth. The attachment elements 1233-1 . . .1233-5 can, for instance, provide friction between the dental applianceand the teeth to increase retention of the dental appliance. That is,the attachment elements 1233-1 . . . 1233-5 can create greater retentionof the dental appliance in a particular direction.

FIG. 12D illustrates a front view of an upper jaw 1202 with a firstrepositioning jaw element 1206 and a third repositioning jaw element1210 and a lower jaw 1204 with a second repositioning jaw element 1208and a fourth repositioning jaw element 1212 according to a number ofembodiments of the present disclosure.

In various embodiments, at least one of the repositioning jaw elements1206, 1208, 1210, 1212 can be shaped to minimize and/or preventdegrading the retention and/or functionality of the shell of the dentalappliance. For example, as illustrated in the embodiment of FIG. 12D,the buccal-lingual width of a repositioning jaw element (e.g., therepositioning jaw elements 1206, 1208, 1210, 1212) can be different onan occlusal surface of the repositioning jaw element (e.g., top surface)than on a buccal-lingual width of a surface of the repositioning jawelement adjacent to the shell (e.g., bottom surface). That is, the sidesurfaces of the repositioning jaw elements can be tapered inward towardthe bottom surface. For instance, the buccal-lingual width of arepositioning jaw element can be wider on an occlusal surface of therepositioning jaw element than on a buccal-lingual width of a surface ofthe repositioning jaw element adjacent to the shell. Such a shape can besimilar to the construction of an I-beam with the wider buccal-lingualocclusal surface interfacing with an occlusal surface of a repositioningjaw element positioned on an opposing jaw.

FIGS. 13A-13B illustrate examples of side surface features according toa number of embodiments of the present disclosure. The side surfacefeatures and jaws illustrated in FIGS. 13A-13B can include virtual sidesurface features and virtual jaws of a patient or physical molds of apatient's jaws with side surface features, in some embodiments.

A side surface feature, as used herein, can extend beyond the occlusalplane of a removable dental appliance to engage with buccal and lingualcoronal side surfaces of at least one tooth and/or a removable dentalappliance on the opposite jaw of the patient. The side surface featurescan, for instance, add retention to molar teeth to balance movementcreated by the repositioning jaw elements and/or prevent and/or limit aposterior surface of the removable dental appliance from contactingmolars. In various embodiments, the side surface features can includerepositioning jaw elements. That is, although not illustrated by theembodiments of FIGS. 13A-13B, the side surface features can be used inaddition to repositioning jaw elements, such as repositioning jawelements 106, 108 illustrated in FIG. 1A.

FIG. 13A illustrates posterior view of an upper jaw 1302 and a lower jaw1304 with a number of side surface features 1335-1, 1335-2, 1337-1,1337-2, 1337-3 according to a number of embodiments of the presentdisclosure. As illustrated by FIG. 13A, the number of side surfacefeatures can include buccal side surface features 1335-1, 1335-2 andlingual side surface features 1337-1, 1337-2, 1337-3.

FIG. 13B illustrates a view of a posterior side of the upper jaw 1302and the lower jaw 1304 with the number of side surface features 1335-1,1335-2, 1337-1, 1337-2. The upper jaw 1302, the lower jaw 1304, and thenumber of side surface features 1335-1, 1335-2, 1337-1, 1337-2illustrated in FIG. 13B can include the same or different jaws and sidesurface features as illustrated in FIG. 13A, in various embodiments.

The side surface features 1335-1, 1335-2, 1337-1, 1337-2, as illustratedby FIG. 13B, can include a pair of side surface features (e.g., a firstbuccal side surface feature 1335-1 and a first lingual side surfacefeature 1337-1) on the first posterior side of the upper jaw 1302 and apair of side surface features (e.g., a second buccal side surfacefeature 1335-2 and a second lingual side surface feature 1337-2) on thesecond posterior side of lower jaw 1304. Each pair of side surfacefeatures (e.g., the first buccal side surface feature 1335-1 and thefirst lingual side surface feature 1337-1) can engage with side surfacesof at least one tooth and/or a removable dental appliance on theopposite jaw of the patient.

The side surface features 1335-1, 1335-2, 1337, 1, 1337-2, 1337-3illustrated by FIGS. 13A-13B and the side surface features 1335-1,1335-2 illustrated by FIGS. 13C-D are illustrated as dotted surfaces forclarity purposes. However, in accordance with the present disclosure,the side surface features can be the same color, texture, and/or formedof the same material as the shells 1314, 1316, the virtual jaws, and/orphysical molds of the jaw (e.g., the upper jaw 1302 and the lower jaw1304).

FIGS. 13C-D illustrate a side view of a first shell with a first sidesurface feature and a second shell with a second side surface featureaccording to a number of embodiments of the present disclosure. Aspreviously discussed, in some embodiments the number of side surfacefeatures 1335-1, 1335-2 can include repositioning jaw elements extendingfrom buccal and/or lingual surfaces of a dental appliance (e.g.,shells).

That is, the first side surface feature 1335-1 of the first shell 1314can include a first surface 1328 that can interface with a secondsurface 1330 of the second side surface feature 1335-2 of the secondshell 1316. The second side surface feature 1335-2 can include thesecond surface 1330 that can interface with the first surface 1328 ofthe first side surface feature 1335-1.

A shell with a repositioning jaw element, such as the first shell 1314with the first repositioning jaw element (e.g., the first side surfacefeature 1335-1) and the second shell 1316 with the second repositioningjaw element (e.g., the second side surface feature 1335-2), includecontinuous dental appliances that contain geometries (e.g., therepositioning jaw elements) that act as jaw repositioning elements. Thatis, the repositioning jaw elements are geometries of the shells 1314,1316, and not separate elements attached there to.

For example, as illustrated by the embodiment of FIG. 13D, the firstrepositioning jaw element (e.g., the first side surface feature 1335-1)and the second repositioning jaw element (e.g., the second side surfacefeature 1335-2) can be positioned to interface, interact, and/orotherwise engage in the presence of a fully engaged sagittal jawposition of the patient's upper dentition (e.g., the upper jaw 1302illustrated in FIGS. 13A-13B) and the patient's lower dentition (e.g.,the lower jaw 1304 illustrated in FIGS. 13A-13B) in a manner toreposition the patient's lower jaw.

The repositioning jaw elements can be angled 1339-1, 1339-2 to createand/or aim for an ideal fit. An ideal fit of repositioning jaw elements,as previously discussed, is a fit of the repositioning jaw elements thatresults in repositioning of the patient's jaw (e.g., repositioningtowards a corrected jaw position) and/or minimizes discomfort for apatient.

The repositioning jaw elements, in some embodiments, can be angled1339-1, 1339-2 away from the shells 1314, 1316 of the dental applianceto avoid collision with the shell of the opposing jaw. However, in someembodiments, the angle 1339-1, 1339-2 can be the minimum possible angleto minimize protrusion of the repositioning jaw elements into thecheeks, tongue, and/or other tissue of the patient (e.g.,prevent/minimize discomfort) while being great enough to avoid collisionwith the shell 1314, 1316 of the opposing jaw (and/or to crisscross whenanteriorly or posteriorly viewed, as previously discussed in connectionwith FIG. 6).

As illustrated by FIGS. 13C-13D, the repositioning jaw elements (e.g.,the first and second side surface features 1335-1, 1335-2) cancrisscross (when viewed anteriorly or posteriorly) and bothrepositioning jaw elements can extend past an occlusal surface of therespective jaws and/or shells 1314, 1316. For example, the firstrepositioning jaw element extends past the occlusal surface of the upperjaw and/or the first shell 1314 and the second repositioning jaw elementextends past the occlusal surface of the lower jaw and/or the secondshell 1316. Extending both repositioning jaw elements past the occlusalsurface of the respective jaws and/or shells 1314, 1316 can minimize theheight of the first repositioning jaw element (or second repositioningjaw element) as compared to extending only one of the repositioning jawelements past the occlusal surface of the respective jaw and/or shell.

FIGS. 14A-14B illustrate examples of repositioning jaw elements foradjusting a midline of a patient according to a number of embodiments ofthe present disclosure. The repositioning jaw elements and jawsillustrated in FIGS. 14A-14B can include virtual repositioning jawelements and virtual jaws of a patient or physical molds of a patient'sjaws with repositioning jaw elements, for instance.

In accordance with a number of embodiments of the present disclosure,the repositioning jaw elements can be used to adjust a midline of apatient. A midline of a patient, as used herein, can include amidsagittal line of the teeth of the upper jaw and the teeth of thelower jaw of the patient.

For instance, repositioning jaw elements can be placed on the right andleft posterior side of a shell for the upper jaw and the right and leftposterior side of a shell for the lower jaw. The surfaces ofrepositioning jaw elements on the shell of each jaw that are designed tointerface, interact, and/or engage surfaces of repositioning jawelements on an opposing jaw can be angled at the same angle and/oropposite angles, in various instances. For example, for minor adjustmentto the midline of a patient, the surfaces of repositioning jaw elementson the shell of a jaw (e.g., upper or lower) can be angled at opposingangles. In contrast, for larger adjustments to the midline of thepatient, the surfaces of repositioning jaw elements (e.g., the right andleft posterior side) on the shell of a jaw (e.g., upper or lower) can beangled at the same angle.

FIG. 14A illustrates an example of a side view of an upper jaw 1402 witha first repositioning jaw element 1406 and a third repositioning jawelement 1410 and a lower jaw 1404 with a second repositioning jawelement 1408 and a fourth repositioning jaw element 1412. The firstrepositioning jaw element 1406 and second repositioning jaw element1408, and the third repositioning jaw element 1410 and the fourthrepositioning jaw element 1412, respectively, can be designed tointerface, interface, and/or engage in the present of a fully engagedsagittal jaw position to guide the lower jaw 1404 of the patient in amesial-distal direction.

In various embodiments, the guidance of the lower jaw 1404 in amesial-distal direction can be concurrent with guiding the lower jaw1404 in a forward or backward direction (e.g., anterior-posteriordirection). That is, the midline of the patient can be adjustedconcurrently with adjusting the sagittal jaw position of the patientusing the repositioning jaw elements 1406, 1408, 1410, 1412.

FIG. 14B illustrates an example of a view of an upper jaw 1402 with afirst repositioning jaw element 1406 and a third repositioning jawelement 1410 and a lower jaw 1404 with a second repositioning jawelement 1408 and a fourth repositioning jaw element 1404. The jaws 1402,1404 and repositioning jaw elements 1406, 1408, 1410, 1412 illustratedin FIG. 14B can include the same or different jaws/repositioning jawelements as illustrated in FIG. 14A, in various embodiments.

As illustrated by the embodiment of FIG. 14B, in a number ofembodiments, the surfaces of the repositioning jaw elements (e.g., theright and left posterior side) on the shell of a jaw (e.g., upper orlower) can be angled at the same angle. For instance, the firstrepositioning element 1406 and the third repositioning jaw element 1410of the first jaw 1402 are angled at the same angle (e.g., a firstangle). Similarly, the second repositioning jaw element 1408 and thefourth repositioning jaw element 1412 are angled at the same angle(e.g., a second angle), which can be an opposite angle as the firstrepositioning jaw element 1406 and the third repositioning jaw element1410. However, embodiments in accordance with the present disclosure arenot so limited. For instance, the surfaces of repositioning jaw elementson the shell of a jaw (e.g., upper or lower) can be angled at opposingangles, in a number of embodiments.

Further, the embodiments illustrated by FIGS. 14A-14B can includerepositioning jaw elements 1406, 1408, 1410, 1412 that adjust themidline of a patient toward the patient's right side. However,embodiments in accordance with the present disclosure are not so limitedand can include repositioning jaw elements designed to adjust themidline of a patient toward the patient's left side.

FIGS. 15A-B illustrates a side view of a first shell with a firstrepositioning jaw element and a second shell with a second repositioningjaw element according to a number of embodiments of the presentdisclosure. As previously discussed, the first shell 1514 can include anumber of tooth apertures configured to receive and reposition a numberof teeth of a patient's upper dentition. A first repositioning jawelement 1506 extends from an occlusal surface of the first shell 1514.

The second shell 1516 can include a number of tooth apertures configuredto receive and reposition a number of teeth of the patient's lowerdentition. A second repositioning jaw element 1508 extends from anocclusal surface of the second shell 1516.

The repositioning jaw elements 1506, 1508 can include a number ofsurfaces 1528, 1530, 1543, 1547, 1549, 1555. For instance, as previouslydiscussed, the first repositioning jaw element 1506 can include a firstsurface 1528 and the second repositioning jaw element 1508 can include asecond surface 1530 to interface with the first surface 1528 of thefirst repositioning jaw element 1506. The first repositioning jawelement 1506 and the second repositioning jaw element 1508 can bepositioned to interface, interact, and/or otherwise engage in thepresence of a fully engaged sagittal jaw position of the patient's upperdentition and the patient's lower dentition in a manner to repositionthe patient's lower jaw.

The number of surfaces 1528, 1530, 1543, 1547, 1549, 1555 can includetop surfaces 1543, 1547 of the repositioning jaw elements 1506, 1508, aspreviously discussed. The top surface 1543 of the first repositioningjaw element 1506 can include a slanted top surface. As previouslydiscussed, a slanted top surface can include a slant in height from thefirst surface 1528 designed to interface, interact, and/or otherwiseengage with one another surface to a back surface (e.g., back surface538 as illustrated by FIG. 5C) of the first repositioning jaw element1506. For instance, the slanted top surface 1543 of the firstrepositioning jaw element 1506 can include a higher coronal-apicalheight of a repositioning jaw element in a mesial direction than acoronal-apical height of the repositioning jaw element in a distaldirection. In some embodiments, the top surface 1547 of the secondrepositioning jaw element 1508 can include a slanted top surface, asillustrated by FIG. 16A.

As previously discussed in connection with FIG. 5C and FIG. 6, theslanted top surface 1543 of the first repositioning jaw element 1506 cancreate a more comfortable experience for the patient as the jaw of thepatient may not close in a flat direction (e.g., not parallel to ahorizontal plane). Further, the top surface 1543 that is slanted canprevent and/or minimize the top surface 1543 of the first repositioningjaw element 1506 from interfacing with surfaces of the shell of theopposing jaw (as discussed further herein).

FIG. 15A illustrates an ideal fit of a first repositioning element 1506of a first shell 1514 and a second repositioning element 1508 of asecond shell 1516 with a predicted corrected jaw position that isaccurate. That is, the predicted (e.g., calculated) corrected jawposition can be the same and/or near same as the actual corrected jawposition of the patient. As illustrated, the top surface 1547 of thesecond repositioning jaw element 1508, in an ideal fit, can be flushwith the first plane of material 1555 on the first shell 1514, asdiscussed further herein.

In various embodiments, the number of surfaces 1528, 1530, 1543, 1547,1549, 1555 can include a plane of material 1549, 1555 extending from therepositioning jaw elements 1506, 1508. A plane of material 1549, 1555can include additional material on an occlusal surface of the shell. Thematerial can include the same material that forms the shells 1516, 1514.

As illustrated by FIGS. 15A-15B, a first plane of material 1555 on thefirst shell 1514 can extend from the first repositioning jaw element1506 in a mesial direction. A second plane of material 1549 on thesecond shell 1516 can extend from the second repositioning element 1508in a distal direction. The planes of material 1549, 1555 can be used toprevent and/or minimize forces on coronal surfaces of teeth beneath therepositioning jaw elements 1506, 1508.

For instance, the first plane of material 1555 can prevent and/orminimize forces created when a patient closes their jaw (e.g., jawclosing forces) from being applied to teeth beneath the first plane ofmaterial 1555 and/or beneath the second repositioning jaw element 1508.In an ideal fit of the repositioning jaw elements 1506, 1508, the firstplane of material 1555 can contact the top surface 1547 of the secondrepositioning jaw element 1508. However, in some embodiments, thecontact may be present but can, for example, not be a flush contact.

The slanted top surface 1543 of the first repositioning jaw element 1506can allow for errors in a prediction of the corrected jaw position. Ifan accurate corrected jaw position is calculated, an ideal position ofthe repositioning jaw elements 1506, 1508 can include the first surface1528 and the second surface 1530 being in flush contact and the topsurface 1547 of the second repositioning jaw element 1508 being in flushcontact with the first plane of material 1555.

However, some error in predicting the corrected jaw position can occur.For example, FIG. 15B illustrates an ideal fit of a first repositioningjaw element 1506 and a second repositioning jaw element 1508 with apredicted corrected jaw position that has some error (e.g., is notaccurate) from an actual corrected jaw position of the patient. Asillustrated by FIG. 15B, a gap between the top surface 1547 of thesecond repositioning jaw element 1508 and the first plane of material1555 can occur while still having contact between the first surface 1528and the second surface 1530. If the device were designed to have flushcontact between the top surface 1543 and the second plane of material1549, and there was error in predicting the corrected jaw position ascompared to the actual corrected jaw position of the patient, then thejaws of the patient may be open more than intended and/or desired due tothe top surface 1543 not having flush contact with the second plane ofmaterial 1549.

In some embodiments, the second plane of material 1549 can preventand/or minimize forces created when the patient closes their jaw frombeing applied to teeth beneath the second plane of material 1549 and/orbeneath the first repositioning jaw element 1508. In an ideal fit of therepositioning jaw elements 1506, 1508, the second plane of material 1549does not contact the top surface 1543 of the first repositioning jawelement 1506. However, in some embodiments, contact may be present butmay not be a flush contact.

The mesial-distal distance of each plane of material 1549, 1555 can bebased on the mesial-distal distance of the repositioning jaw element onthe opposing jaw. For instance, the first plane of material 1555 canextend in a mesial direction from the first repositioning jaw element1506 for the same and/or near same mesial-distal distance as the secondrepositioning jaw element 1508 on the opposing jaw extends. The secondplane of material 1549 can extend in a distal direction from the secondrepositioning jaw element 1508 for the same and/or near samemesial-distal distance as the first repositioning jaw element 1506 onthe opposing jaw extends.

The slanted top surface 1543 of the first repositioning jaw element 1506in addition with one or more planes of material 1549, 1555 can be usedto create and/or aim for an ideal fit of the repositioning jaw elements1506, 1508. In some embodiments, an ideal fit of the repositioning jawelements 1506, 1508 extending from an occlusal surface of the shells1514, 1516 can include the first surface 1528 of the first repositioningjaw element 1506 interfacing (e.g., contacting) with the second surface1530 of the second repositioning jaw element 1508, the top surface 1547of the second repositioning jaw element 1508 interfacing with the firstplane of material 1555, and the top surface 1543 of the firstrepositioning jaw element 1506 not interfacing with (e.g., contacting)the second plane of material 1549 of the second repositioning jawelement 1508, as illustrated by FIG. 15A.

The angle of the slanted top surface 1543 and the plane of materials1549, 1555 can prevent and/or minimize forces on the coronal surfaces ofteeth located beneath the repositioning jaw elements 1506, 1508, and,can allow for the first and the second surfaces 1528, 1530 of therepositioning jaw elements 1506, 1508 to interface to move a position ofa misaligned jaw of the patient. For instance, one or more of the topsurfaces 1543, 1547 interfacing with one or more of the planes ofmaterial 1549, 1555 may prevent and/or minimize the first surface 1528from interfacing with the second surface 1530 in a manner to repositionthe patient's lower jaw.

However, embodiments in accordance with the present disclosure are notlimited to the fit of the repositioning jaw elements illustrated byFIGS. 15A-15B. For instance, over time, as a patient wears the firstshell 1514 and the second shell 1516, the ideal fit may not exist. Thatis, the top surfaces 1543, 1547 may or may not contact the planes ofmaterial 1549, 1555 as intended when worn by a patient.

The angle of the slanted top surface 1543 of the first repositioning jawelement 1506 can be a set angle for any patient and/or can include acustomized angle for a particular patient. A customized angle, as usedherein, can include an angle that is revised based on patient data. Forinstance, an angle of the slanted top surface 1543 can be customized fora particular patient using articulation information of the patient.Articulation information can be information on positioning and/ormovement of the jaw of a patient. Articulation information can beobtained from a scan of the patient's mouth, among other techniques.

In some embodiments, the second plane of material 1549 extending fromthe second repositioning jaw element 1508 may not be present. Forinstance, in some mandibular advancement cases, the second plane ofmaterial 1549 may not be necessary to prevent the top surface 1543 ofthe first repositioning jaw element 1506 from interfacing with a surfaceof the second shell 1516 on the opposing jaw of the patient.

In various embodiments, even if the second plane of material 1549 is notused for an ideal fit, the second plane of material 1549 may be used asa region for labeling for manufacturing purposes. For instance,identification information (e.g., numbers and/or letters) can be addedto the second plane of material 1549.

FIG. 16A illustrates a side view of a first shell with a firstrepositioning jaw element and a second shell with a second repositioningjaw element according to a number of embodiments of the presentdisclosure. As previously discussed, the first shell 1614 can include anumber of tooth apertures configured to receive and reposition a numberof teeth of a patient's upper dentition. A first repositioning jawelement 1606 extends from an occlusal surface of the first shell 1614.

The second shell 1616 can include a number of tooth apertures configuredto receive and reposition a number of teeth of the patient's lowerdentition. A second repositioning jaw element 1608 extends from anocclusal surface of the second shell 1616.

As illustrated by FIG. 16A, in some embodiments, the top surfaces 1647(and 1543 illustrated by FIGS. 15A-15B) of the first repositioning jawelement 1606 and the second repositioning jaw element 1608 can beslanted. Having a slanted top surface 1647 of the second repositioningjaw element 1608 and a slanted top surface (e.g., illustrated by 1543 ofFIGS. 15A-15B) of the first repositioning jaw element 1606 canstreamline a profile of the dental appliance (e.g., the first shell 1614and the second shell 1616).

As further illustrated by FIG. 16A, in a number of embodiments, thefirst shell 1614 can include an anterior stop 1657. An anterior stop1657 can include a tripod support located at the anterior region of thepatient (e.g., proximal to anterior teeth of the patient). The anteriorstop 1657 can be formed integrally with and/or of the same material asthe first shell 1614 (or the second shell 1616), in accordance with anumber of embodiments.

For example, the anterior stop 1657 can extend from the occlusal surfaceof the first shell 1614 proximal to anterior teeth of the upper jaw. Theanterior stop 1657 can rest on the occlusal surface of the second shell1616 when pressure is placed on the first shell 1614 and the secondshell 1616 by the patient.

Alternatively, the anterior stop 1657 can extend from the occlusalsurface of the second shell 1616 proximal to anterior teeth of the lowerjaw. The anterior stop 1657 can rest on the occlusal surface of thefirst shell 1614 when pressure is placed on the first shell 1614 and thesecond shell 1616 by the patient.

In some instances, an arch of a patient may not be parallel. Forexample, a patient with a high angled mandible, any opening (e.g.,posterior opening) created by the repositioning jaw elements 1606, 1608can lead to a large anterior opening. As an example, the opening caninclude a 1 to 3 ratio (e.g., for every 1 mm opening in the posteriorregion, a resulting 3 mm opening in the anterior region of the patient).If the patient pivots around to a back contact point, there can be jawstrain and discomfort.

The anterior stop 1657, as previously discussed, can rest on theocclusal surface of the second shell 1616 when pressure is placed on thefirst shell 1614 and the second shell 1616 by the patient to providesupport when the patient has fully rested their jaws. Further, theanterior stop 1657 can reduce pressure on the repositioning jaw elements1606, 1608, which can reduce associated flaring.

FIG. 16B illustrates a cross-sectional view of the second repositioningjaw element 1608 according to a number of embodiments of the presentdisclosure. As illustrated by FIG. 16B, in some embodiments, the secondrepositioning jaw element 1608 can be structured as rigid protrusions(e.g., fins) for adaptation to a molar.

A second repositioning jaw element 1508, as illustrated by FIG. 15B, canlose adaptation to the tooth surface beneath and may lead to flaring ofthe second shell 1516 when pressure is placed on the secondrepositioning jaw element 1508. By contrast, the rigid protrusions, asillustrated by FIG. 16B, can reduce flaring (e.g., buccal-lingualflaring) of the shell.

FIG. 17 illustrates a side close-up view of a repositioning jaw elementreinforcement structure according to a number of embodiments of thepresent disclosure. Similar to the embodiments of FIG. 13A-D, therepositioning jaw elements, in the embodiments of FIGS. 17-21, can beangled away from the coronal surface of the shell of the dentalappliance (e.g., as shown in FIGS. 18A and 19) to avoid collision withthe shell of the opposing jaw. In this manner, the elements can provideforce to urge the jaws into proper position, but can also allow thepatient to close their bite almost fully (there will still be somedental appliance material between the bite surfaces of the teeth).

As illustrated by FIGS. 20 and 21, the repositioning jaw elements cancrisscross (when viewed anteriorly or posteriorly) and bothrepositioning jaw elements can extend past an occlusal surface of therespective jaws and/or shells. For example, the first repositioning jawelement extends past the occlusal surface of the upper jaw and/or thefirst shell and the second repositioning jaw element extends past theocclusal surface of the lower jaw and/or the second shell. Extendingboth repositioning jaw elements past the occlusal surface of therespective jaws and/or shells can minimize the height of the firstrepositioning jaw element (or second repositioning jaw element) ascompared to extending only one of the repositioning jaw elements pastthe occlusal surface of the respective jaw and/or shell, in someembodiments.

In the embodiment of FIG. 17, one repositioning jaw element 1782 isshown on a shell 1780 that includes a number of apertures 1788 to beplaced over a number of teeth. The shell 1780 can be used for mandibularadjustment and, in some applications, can also be used for the movementof one or more teeth as described herein.

In an example embodiment, such as that shown in FIG. 17, a removabledental appliance can include a shell 1780 having a number of toothapertures 1788 configured to receive and reposition a number of teeth ofa patient along one jaw of a patient. The shell 1780 also includes arepositioning jaw element 1782 that extends from a buccal or lingualsurface of the shell. In the case of the embodiment illustrated in FIG.17, the repositioning jaw element 1782 is on the buccal surface.

The repositioning jaw element 1782 has a first outer surface oriented toface the tongue of the patient (not shown in the view of FIG. 17) and asecond outer surface 1786 oriented to face the cheek of the patient. Inthe illustrated embodiment of FIG. 17, a reinforcement member 1784 isformed along at least one of the first and second outer surfaces (secondouter surface 1786 in FIG. 17) to provide reinforcement of the element.

The reinforcement structure can be used to strengthen the repositioningjaw element 1782 with respect to forces from interaction with teeth or ashell on the opposing jaw or other repositioning jaw elements on theshell of the opposing jaw. Forces from such structures can includeupward/downward forces on the repositioning jaw element, front/backforces (which may wear the side surfaces of the repositioning jawelement (1796 of FIG. 17, for example)), and side to side forces (e.g.,forces that may bend the repositioning jaw element outward, away fromthe bite surface (1892 of FIG. 18) of the tooth).

As shown in FIG. 17, in some embodiments, the reinforcement member 1784can be oriented generally perpendicular to a jaw line 1789 of a patient.As used herein, generally perpendicular can be within a range of 70-90degrees from the jawline, however, the reinforcement member does nothave to be generally perpendicular in all embodiments herein andtherefore can be at angles greater or less than that range.

In such embodiments, the jaw line can be identified based on a number ofpoints along the top surface of the jaw, based on mid-points within thejaw, or based on alignment of the teeth on the jaw as shown in FIG. 17,among other alignment mechanisms. The orientation of the reinforcementmember 1784 can also be determined based on estimated forces that may beapplied to the repositioning jaw element 1782. For example, if estimatedforces indicate that one side of surface 1786 of the repositioning jawelement will have more force applied to it than the other side then thereinforcement member 1784 can be positioned closer to the side that mayhave more force.

As shown in FIG. 17, the surface 1786 can be a curved surface (shaped toconform to the surface of a tooth) and the reinforcement member 1782 canbe formed beyond the curvature of the outer surface. This can bebeneficial as forming it outside the curvature allows for areinforcement of the strength of the repositioning jaw element 1782.

FIGS. 18A and 18B illustrate perspective views of a mandibularadvancement reinforcement structure according to a number of embodimentsof the present disclosure. In the embodiment of FIGS. 18A and 18B, onerepositioning jaw element 1882 is shown on a shell 1880 that includes anumber of apertures 1888 to be placed over a number of teeth.

The repositioning jaw element 1882 has a first outer surface 1898oriented to face the tongue of the patient and a second outer surface(not shown in the view of FIGS. 18A and 18B) oriented to face the cheekof the patient. In the illustrated embodiment of FIGS. 18A and 18B, aplurality of reinforcement members 1894-1 and 1894-2 are formed along atleast one of the first and second outer surfaces (first outer surface1898 in FIGS. 18A and 18B) to provide reinforcement of the element.

In some embodiments, the first outer surface and the second outersurface can each have at least one reinforcement member providedthereon. For instance, the repositioning jaw element 1882 can havereinforcement members 1894-1 and 1894-2 formed on one outer surface andhave a reinforcement member similar to 1784 from FIG. 17 formed on theother outer surface.

As discussed above, the reinforcement structures can be used tostrengthen the repositioning jaw element 1882 with respect to forcesfrom interaction with teeth or a shell on the opposing jaw or otherrepositioning jaw elements on the shell of the opposing jaw. Forces fromsuch structures can include upward/downward forces on the repositioningjaw element, front/back forces which may wear the side surfaces of therepositioning jaw element, and side to side forces (e.g., forces thatmay bend the repositioning jaw element outward, away from the bitesurface 1892 of the tooth.

FIG. 19 illustrates an elevated perspective view of a virtual model foruse in creating repositioning jaw elements having buccal and lingualreinforcement structures according to a number of embodiments of thepresent disclosure. FIG. 19 shows an example of a virtual model that canbe used to create the repositioning jaw element structures in the shellof the dental appliance. For example, in embodiments where the shell iscreated by thermoforming, a polymer material is vacuum sucked over aphysical mold that usually contains shapes of the patient's teeth,gingiva, and other features of the patient's anatomy and/or features tobe incorporated into the shell.

In the embodiment of FIG. 19, the virtual model can be created by acomputing device as described herein and a physical model can be createdfrom the virtual model. In some embodiments, a physical model can becreated without utilizing a virtual model. As shown in the embodiment ofFIG. 19, the virtual model (and physical model) 1990 can have gingivalstructure 1995, one or more teeth 1985, and a repositioning jaw element1981.

As discussed above, the repositioning jaw element can include at leastone reinforcement member on the first outer surface and at least onereinforcement member on the second outer surface. For example, in FIG.19, the repositioning jaw element shape 1981 has a first outer surfaceoriented to face the tongue of the patient and a second outer surfaceoriented to face the cheek of the patient and a plurality ofreinforcement member shapes 1993-1 and 1993-2 are formed along the firstsurface with a reinforcement member shape 1983 formed along the secondouter surface to provide reinforcement of the element.

When the shell material is vacuum sucked over these shapes, therepositioning jaw element with reinforcement members will be created. Insuch embodiments, since the repositioning jaw element and thereinforcement members are formed from a unitary form (including both therepositioning jaw element shape and reinforcement member shape) thereinforcement member forms a cavity therein that is open to an interiorcavity of the repositioning jaw element.

In some embodiments, the repositioning jaw element includes at least onereinforcement member on the first outer surface and at least tworeinforcement members on the second outer surface. In such embodiments,a first reinforcement member on the second outer surface can bepositioned on a first edge of the outer surface and a secondreinforcement member on the second outer surface is positioned on asecond edge of the outer surface, as shown in the embodiment of FIG. 19.As used herein the edge of the outer surface is where the outer surfacetransitions into the side surface (e.g., where reinforcement member1894-2 is positioned at the edge of surface 1898 at or near where thesurface 1898 transitions into side surface 1896 in FIG. 18B).

This can be beneficial, for example, where more force may be applied toside surface 1991 and its opposing side surface (obscured in FIG. 19 byreinforcement member 1993-1) or to spread the reinforcement benefit overa larger portion of the surface on which the reinforcement members areformed. Additionally, the first and second repositioning jaw elementscan each have a first outer surface oriented to face the tongue of thepatient surface and a second outer surface oriented to face the cheek ofthe patient and each surface can include a reinforcement member formedon the outer surfaces to provide reinforcement of the element.

FIG. 20 illustrates a side perspective view of a virtual model for usein creating repositioning jaw elements having buccal reinforcementstructures according to a number of embodiments of the presentdisclosure. As discussed above, FIGS. 20 and 21 illustrate embodimentswhere the repositioning jaw elements crisscross (when viewed anteriorlyor posteriorly) and both repositioning jaw elements can extend past anocclusal surface of the respective jaws and/or shells.

For example, the first repositioning jaw element extends past theocclusal surface of the upper jaw and/or the first shell and the secondrepositioning jaw element extends past the occlusal surface of the lowerjaw and/or the second shell. Extending both repositioning jaw elementspast the occlusal surface of the respective jaws and/or shells canminimize the height of the first repositioning jaw element (or secondrepositioning jaw element) as compared to extending only one of therepositioning jaw elements past the occlusal surface of the respectivejaw and/or shell.

The embodiment of FIG. 20, the virtual model 2090 includes upper andlower jaws including gingival structures 2095-1 and 2095-2 and teeth2085. The model 2090 also includes a repositioning jaw element shape2081-1 having a reinforcement member shape 2083-1 and repositioning jawelement shape 2081-2 having a reinforcement member shape 2083-2 that areused to form the repositioning jaw elements and reinforcement members onupper and lower jaw shells that cooperate to provide mandibularadjustment.

In such an embodiment, the sides 2091-1 and 2091-2 contact each other asthe patient closes their bite and urges mandibular adjustment. Forexample, in one embodiment, a removable dental appliance system caninclude a first shell having tooth apertures configured to receive teethof a patient's upper dentition and a second shell having tooth aperturesconfigured to receive teeth of the patient's lower dentition. Theexample embodiment also includes a first repositioning jaw element thatextends from a buccal or lingual surface of the first shell and includesa first surface and a second repositioning jaw element that extends froma buccal or lingual surface of the second shell and includes a secondsurface to interface with the first surface of the first repositioningjaw element.

The first repositioning jaw element and the second repositioning jawelement can be positioned to interface as the patient moves to a fullyengaged sagittal jaw position of the patient's upper dentition and thepatient's lower dentition in a manner to reposition the patient's jawand wherein the first repositioning jaw element and the secondrepositioning jaw element crisscross when interfacing. The at least oneof the first and second repositioning jaw elements has a first outersurface oriented to face the tongue of the patient surface and a secondouter surface oriented to face the cheek of the patient and includes areinforcement member formed along at least one of the first and secondouter surfaces to provide reinforcement of the element. In this manner,the cooperating repositioning jaw elements aid in mandibular adjustmentas their surfaces contact each other.

FIG. 21 illustrates an elevated perspective view of a virtual model foruse in creating repositioning jaw elements having buccal reinforcementstructures according to a number of embodiments of the presentdisclosure. The embodiment of FIG. 21, the virtual model 2190 includesupper and lower jaws including gingival structures 2195-1 and 2195-2 andteeth 2185. The model 2190 also includes a repositioning jaw elementshape 2181-1 having reinforcement member shapes 2193-1 and 2193-2 andrepositioning jaw element shape 2181-2 having reinforcement membershapes 2193-3 and 2193-4 that are used to form the repositioning jawelements and reinforcement members on upper and lower jaw shells thatcooperate to provide mandibular adjustment.

As discussed above, a computing device can be used to create a virtualmodel and/or machine executable instructions for creating a physicalmodel or direct fabrication (three dimensional printing or other directmanufacturing process) for the creation of the shells described herein.For example, in one embodiment, a removable dental appliance formationsystem includes a non-transitory computing device readable mediumstoring instructions executable by a processor to cause a computingdevice to perform a method.

An example method can include identifying a misaligned jaw of a patientfrom a virtual image of the patient's jaw and providing a treatment planfor the patient including a virtual model of a dental appliance having afirst shell and a second shell configured to reposition at least onetooth of the patient, the virtual model of the dental applianceincluding repositioning jaw elements on the first shell and the secondshell configured to move a position of the misaligned jaw of the patientand wherein the at least one of the first and second repositioning jawelements has a first outer surface oriented to face the tongue of thepatient surface and a second outer surface oriented to face the cheek ofthe patient and includes a reinforcement member formed along at leastone of the first and second outer surfaces to provide reinforcement ofthe element.

In some embodiments, the non-transitory computing device readable mediumstoring instructions include instructions for fabricating a physicalmodel for forming at least the first shell. The system can also includea dental mold formation apparatus (thermo-forming device, threedimensional printing device, etc.) for receiving the instructions forfabricating the physical model and applying one or more materials tofabricate the physical model.

For instance, as discussed above, the physical model includes a solidshape onto which a material is thermoformed over to create the firstshell of the appliance. For example, in various embodiments, the solidform can include a solid shape over which the first repositioning jawelement is formed. The solid form includes a solid shape over which theat least one reinforcement member is formed. Additionally, the solidform can include a solid shape over which the first repositioning jawelement is formed, wherein the solid shape of the first repositioningjaw element has a first outer surface and a second outer surface andwherein the solid form includes a solid shape over which at least onereinforcement member is formed on each of the first and second surfaces.

Such embodiments can be beneficial in allowing the formation ofrepositioning jaw elements and reinforcement members during the samemanufacturing process as the shells. This can reduce cost, time, and/ormaterials in manufacturing, among other benefits.

Listing of Example Embodiments

A. A removable dental appliance comprising:

-   -   a. a first shell having a number of tooth apertures configured        to receive and reposition a number of teeth of a patient's upper        dentition;    -   b. a second shell having a number of tooth apertures configured        to receive and reposition a number of teeth of the patient's        lower dentition;    -   c. a first repositioning jaw element that extends from an        occlusal surface of the first shell and includes a first        surface;    -   d. a second repositioning jaw element that extends from an        occlusal surface of the second shell and includes a second        surface to interface with the first surface of the first        repositioning jaw element;    -   e. wherein:        -   the first repositioning jaw element and the second            repositioning jaw element are positioned to interface in a            presence of a fully engaged sagittal jaw position of the            patient's upper dentition and the patient's lower dentition            in a manner to reposition the patient's jaw;        -   the first repositioning jaw element includes a slanted top            surface; and        -   the first repositioning jaw element and second repositioning            jaw element interface at a slant; and    -   f. wherein the removable dental appliance is configured to        reposition the number of teeth of the patient's upper dentition        and the number of teeth of the patient's lower dentition        concurrently with the repositioning of the patient's jaw.

B. The removable dental appliance of claim A, wherein the slanted topsurface includes a higher coronal-apical height of the firstrepositioning jaw element in a mesial direction of the firstrepositioning jaw element than a coronal-apical height of the firstrepositioning jaw element in a distal direction.

C. The removable dental appliance of claim A, wherein:

the first surface of the first repositioning jaw element includes aslanted surface on a mesial facing surface of the first repositioningjaw element; and

the second surface of the second repositioning jaw element includes aslanted surface on a distal-facing surface of the second repositioningjaw element.

D. The removable dental appliance of claim A, wherein the first shellincludes a plane of material extending from the first repositioning jawelement in a mesial direction.

E. The removable dental appliance of claim D, wherein the plane ofmaterial includes a first plane of material and the second shellincludes a second plane of material extending from the secondrepositioning jaw element in a distal direction.

F. The removable dental appliance of claim A, wherein at least one ofthe first repositioning jaw element and the second repositioning jawelement are positioned to generate distalizing force on at least some ofthe teeth within.

G. The removable dental appliance of claim A, wherein:

-   -   a. the first repositioning jaw element includes a first        geometric feature; and    -   b. the second repositioning jaw element includes a second        geometric feature shaped to mate with the first geometric        feature.

H. The removable dental appliance of claim C, wherein the firstgeometric feature includes a protrusion and the second geometric featureincludes a socket.

I. The removable dental appliance of claim A, wherein at least one ofthe first repositioning jaw element and the second repositioning jawelement include a layer of compressible material on a surface.

J. The removable dental appliance of claim A, wherein at least one ofthe first surface and the second surface are angled to adjust a midlineof patient.

K. The removable dental appliance of claim A, wherein the firstrepositioning jaw element and the second repositioning jaw elementsinclude occlusal surfaces to follow contours of occlusal surfaces ofteeth on an opposing jaw.

L. The removable dental appliance of claim A, wherein at least one ofthe first repositioning jaw element and the second repositioning jawelement include side surface features that extend beyond the occlusalplane of the removable dental appliance to engage with at least one of abuccal and a lingual side surfaces of a shell of an opposite jaw.

M. The removable dental appliance of claim A, wherein the firstrepositioning jaw element and the second repositioning jaw element arepositioned near at least one of an unerupted and a removed molar toothof the patient.

N. The removable dental appliance of claim A, wherein the first shelland the second shell include a plurality of repositioning jaw elementsextending from at least one of a buccal and lingual surface of the firstshell and the second shell.

O. The removable dental appliance of claim A, wherein the firstrepositioning jaw element and the second repositioning jaw elementinclude at least a magnet within to interact and guide the lower jawinto a position.

P. The removable dental appliance of claim A, wherein at least one ofthe first repositioning jaw element and the second repositioning jawelement includes a top surface with a wider buccal-lingual width than abuccal-lingual width of a bottom surface.

Q. A removable dental appliance comprising:

-   -   a. a first shell having a number of tooth apertures configured        to receive and reposition a number of teeth of a patient's upper        dentition;    -   b. a second shell having a number of tooth apertures configured        to receive and reposition a number of teeth of the patient's        lower dentition;    -   c. a first repositioning jaw element that extends from a buccal        or lingual surface of the first shell and includes a first        surface;    -   d. a second repositioning jaw element that extends from a buccal        or lingual surface of the second shell and includes a second        surface to interface with the first surface of the first        repositioning jaw element;    -   e. wherein the first repositioning jaw element and the second        repositioning jaw element are positioned to interface as the        patient moves to a fully engaged sagittal jaw position of the        patient's upper dentition and the patient's lower dentition in a        manner to reposition the patient's jaw and wherein the first        repositioning jaw element and the second repositioning jaw        element crisscross when interfacing; and    -   f. wherein the removable dental appliance is configured to        reposition the number of teeth of the patient's upper dentition        and the number of teeth of the patient's lower dentition        concurrently with the repositioning of the patient's jaw.

R. The removable dental appliance of claim Q, wherein the firstrepositioning jaw element extends past an occlusal surface of the firstshell and the second repositioning jaw element extends past an occlusalsurface of the second shell.

S. The removable dental appliance of claim Q, wherein the crisscross ofthe first repositioning jaw element and the second repositioning jawelement includes a crisscross of the first surface and the secondsurface interfacing when viewed from an anterior or posterior position.

T. The removable dental appliance of claim Q, wherein the firstrepositioning jaw element and the second repositioning jaw elementcomply with an occlusal plane normal of the patient.

U. The removable dental appliance of claim Q, wherein the firstrepositioning jaw element and the second repositioning jaw elementinclude a top groove on a top surface of the repositioning jaw elementsand a number of side grooves on side surfaces of the repositioning jawelements.

V. The removable dental appliance of claim Q, wherein the side groovesinclude coronal-apical grooves positioned at interproximal regions of atleast one tooth of the number of teeth that the repositioning jawelements extend from.

W. The removable dental appliance of claim Q, wherein:

the repositioning jaw element includes a structure to indicate to apatient that the patient has positioned the first and secondrepositioning jaw elements of the first shell and second shell in afully engaged sagittal jaw position.

X. The removable dental appliance of claim Q, wherein:

the first repositioning jaw element and the second repositioning jawelement are positioned to interface as the patient moves to a fullyengaged sagittal jaw position of the patient's upper dentition and thepatient's lower dentition in a manner to reposition the patient's jaw inan anterior-posterior plane with respect to the jaws of the patient.

Y. A removable dental appliance comprising:

-   -   a. a first shell having a number of tooth apertures configured        to receive and reposition a number of teeth of a patient's upper        dentition;    -   b. a second shell having a number of tooth apertures configured        to receive and reposition a number of teeth of the patient's        lower dentition;    -   c. wherein the first shell and the second shell interface in a        presence of a fully engaged sagittal jaw position of the        patient's upper dentition and the patient's lower dentition in a        manner to reposition the patient's jaw; and    -   d. wherein the removable dental appliance is configured to        reposition the number of teeth of the patient's upper dentition        and the number of teeth of the patient's lower dentition        concurrently with the repositioning of the patient's jaw.

Z. The removable dental appliance of claim Y, wherein:

-   -   a. the first shell includes a protrusion; and    -   b. the second shell includes a socket shaped to mate with the        protrusion to move a lower jaw of the patient from an        articulation path of opening to a desired range of jaw opening        extending from a current occluding position.

AA. The removable dental appliance of claim Y, wherein the first shelland the second shell include occlusal surfaces with a geometry thatdiffers from the contours of the occlusal surfaces of the teeth of anopposing jaw.

BB. The removable dental appliance of claim Y, wherein:

-   -   a. the first shell includes a spring; and    -   b. the second shell includes a tab to interact with the spring.

CC. The removable dental appliance of claim Y, wherein the first shelland the second shell each include a plurality of ridges on occlusalsurfaces to guide the jaw into a position.

DD. The removable dental appliance of claim Y, wherein the first shelland the second shell include pairs of magnets within occlusal surfacesof the first shell and the second shell to interact and guide the jaw ofthe patient into a position.

EE. The removable dental appliance of claim Y, wherein occlusal surfacesof the first shell and the second shell include a geometry to match ajaw position.

FF. The removable dental appliance of claim Y, wherein the first shelland the second shell are connected by a rigid or flexible connectingstructure to move a lower jaw into a position.

GG. The removable dental appliance of claim Y, wherein the first shelland the second shell are connected by material at a right posterior sideand a left posterior side of the first shell and the second shell.

HH. The removable dental appliance of claim Y, wherein:

-   -   a. the first shell includes a repositioning jaw element with a        groove; and    -   b. the second shell includes a geometric feature to interact        with the groove.

Although specific embodiments have been illustrated and describedherein, those of ordinary skill in the art will appreciate that anyarrangement calculated to achieve the same techniques can be substitutedfor the specific embodiments shown. This disclosure is intended to coverany and all adaptations or variations of various embodiments of thedisclosure.

It is to be understood that the above description has been made in anillustrative fashion, and not a restrictive one. Combination of theabove embodiments, and other embodiments not specifically describedherein will be apparent to those of skill in the art upon reviewing theabove description. The scope of the various embodiments of thedisclosure includes any other applications in which the above structuresand methods are used. Therefore, the scope of various embodiments of thedisclosure should be determined with reference to the appended claims,along with the full range of equivalents to which such claims areentitled.

In the foregoing Detailed Description, various features are groupedtogether in example embodiments illustrated in the figures for thepurpose of streamlining the disclosure. This method of disclosure is notto be interpreted as reflecting an intention that the embodiments of thedisclosure require more features than are expressly recited in eachclaim.

Rather, as the following claims reflect, inventive subject matter liesin less than all features of a single disclosed embodiment. Thus, thefollowing claims are hereby incorporated into the Detailed Description,with each claim standing on its own as a separate embodiment.

What is claimed is:
 1. A removable dental appliance, comprising: a shellhaving a plurality of tooth apertures configured to receive andreposition a plurality of teeth of a patient along a first jaw of thepatient; a repositioning jaw element that extends from a buccal orlingual surface of the shell, the element having a first outer surfaceoriented to face the tongue of the patient and a second outer surfaceoriented to face the cheek of the patient; and a reinforcement memberformed along at least one of the first and second outer surfaces toprovide reinforcement of the repositioning jaw element, thereinforcement member comprising a channel extending from a gingival lineof the shell at the repositioning jaw element towards a top of therepositioning jaw element and past an occlusal surface of the toothapertures of the shell, the channel being open to an interior cavity ofthe repositioning jaw element.
 2. The removable dental appliance ofclaim 1, wherein the reinforcement member is oriented perpendicular to ajaw line of the patient.
 3. The removable dental appliance of claim 1,wherein the repositioning jaw element has an outer surface with a curvedshape and wherein the reinforcement member is formed beyond thecurvature of the outer surface.
 4. The removable dental appliance ofclaim 1, wherein the repositioning jaw element includes at least onereinforcement member on the first outer surface and at least onereinforcement member on the second outer surface.
 5. The removabledental appliance of claim 1, wherein the repositioning jaw elementincludes at least one reinforcement member on the first outer surfaceand at least two reinforcement members on the second outer surface andwherein a first reinforcement member on the second outer surface ispositioned on a first edge of the outer surface and a secondreinforcement member on the second outer surface is positioned on asecond edge of the outer surface.
 6. A removable dental appliancesystem, comprising: a first shell having tooth apertures configured toreceive teeth of a patient's upper dentition; a second shell havingtooth apertures configured to receive teeth of the patient's lowerdentition; a first repositioning jaw element that extends from a buccalsurface of the first shell and includes a first surface; a secondrepositioning jaw element that extends from a buccal surface of thesecond shell and includes a second surface to interface with the firstsurface of the first repositioning jaw element; wherein the firstrepositioning jaw element and the second repositioning jaw element arepositioned to interface at the first and second surfaces as the patientmoves to a fully engaged sagittal jaw position of the patient's upperdentition and the patient's lower dentition in a manner to repositionthe patient's jaw, and wherein a lingual-facing surface of the firstrepositioning jaw element is angled away from the buccal surface of thefirst shell, and a lingual-facing surface of the second repositioningelement is angled away from the buccal surface of the second shell suchthat the first repositioning jaw element and the second repositioningjaw element crisscross when interfacing; and wherein at least one of thefirst and second repositioning jaw elements has a first outer surfaceoriented to face the tongue of the patient and a second outer surfaceoriented to face the cheek of the patient and includes a reinforcementmember comprising a channel formed along at least one of the first andsecond outer surfaces to provide reinforcement of the at least one ofthe first and second repositioning jaw element, the reinforcement memberextending from a gingival line of the shell at the at least one of thefirst and second repositioning jaw element towards a top of the at leastone of the first and second repositioning jaw element and past anocclusal surface of the tooth apertures of the respective shell, thechannel being open to an interior cavity of the at least one of thefirst and second repositioning jaw element.
 7. The removable dentalappliance system of claim 6, wherein the first repositioning jaw elementextends past an occlusal surface of the first shell and the secondrepositioning jaw element extends past an occlusal surface of the secondshell.
 8. The removable dental appliance system of claim 6, wherein thecrisscross of the first repositioning jaw element and the secondrepositioning jaw element includes a crisscross of the first surface andthe second surface interfacing when viewed from an anterior or posteriorposition.
 9. The removable dental appliance system of claim 6, whereinthe first and second repositioning jaw elements each has a first outersurface oriented to face the tongue of the patient and a second outersurface oriented to face the cheek of the patient and includes areinforcement member formed along the first outer surface to providereinforcement of the first and second repositioning jaw element.
 10. Theremovable dental appliance system of claim 6, wherein the first andsecond repositioning jaw elements each has a first outer surfaceoriented to face the tongue of the patient and a second outer surfaceoriented to face the cheek of the patient and includes a reinforcementmember formed along the second outer surface to provide reinforcement ofthe element.
 11. The removable dental appliance system of claim 6,wherein the first and second repositioning jaw elements each has a firstouter surface oriented to face the tongue of the patient and a secondouter surface oriented to face the cheek of the patient and includes atleast one reinforcement member formed along each of the first and secondouter surfaces to provide reinforcement of the first and secondrepositioning jaw element.
 12. The removable dental appliance system ofclaim 6, wherein the first and second repositioning jaw elements eachhas a first outer surface oriented to face the tongue of the patientsurface and a second outer surface oriented to face the cheek of thepatient and includes at least one reinforcement member on the firstouter surface and at least two reinforcement members on the second outersurface and wherein a first reinforcement member on the second outersurface is positioned on a first edge of the outer surface and a secondreinforcement member on the second outer surface is positioned on asecond edge of the outer surface.